Healthcare Provider Details

I. General information

NPI: 1184766701
Provider Name (Legal Business Name): AMBALAL K PATEL PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 E MAIN ST STE 8
PATCHOGUE NY
11772-3100
US

IV. Provider business mailing address

26 SAMPSON ST
SAYVILLE NY
11782-1313
US

V. Phone/Fax

Practice location:
  • Phone: 631-475-6666
  • Fax: 631-768-9049
Mailing address:
  • Phone: 631-567-3070
  • Fax: 631-968-9049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number031894
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier031894
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerNYSTATE RPH LIC.NO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: