Healthcare Provider Details

I. General information

NPI: 1295058519
Provider Name (Legal Business Name): VRUTIKA PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2010
Last Update Date: 03/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2898 WESTINGHOUSE RD
HORSEHEADS NY
14845-8196
US

IV. Provider business mailing address

3778 WAVERLY RD
OWEGO NY
13827-2836
US

V. Phone/Fax

Practice location:
  • Phone: 607-796-2673
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number052497
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: