Healthcare Provider Details

I. General information

NPI: 1851374953
Provider Name (Legal Business Name): PRAMOD P PATEL BS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 OLYMPIA LN
SICKLERVILLE NJ
08081-4013
US

IV. Provider business mailing address

74 OLYMPIA LN
SICKLERVILLE NJ
08081-4013
US

V. Phone/Fax

Practice location:
  • Phone: 856-262-9049
  • Fax: 856-262-9049
Mailing address:
  • Phone: 856-262-9049
  • Fax: 856-262-9049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI02194300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: