Healthcare Provider Details

I. General information

NPI: 1306252978
Provider Name (Legal Business Name): NIRAV PATEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2014
Last Update Date: 07/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 E PASSYUNK AVE
PHILADELPHIA PA
19147-3017
US

IV. Provider business mailing address

704 E PASSYUNK AVE
PHILADELPHIA PA
19147-3017
US

V. Phone/Fax

Practice location:
  • Phone: 215-627-3151
  • Fax:
Mailing address:
  • Phone: 215-627-3151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP1003859
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: