Healthcare Provider Details

I. General information

NPI: 1932512514
Provider Name (Legal Business Name): DIPA PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2014
Last Update Date: 06/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 WOODHAVEN ROAD
PHILADELPHIA PA
19154
US

IV. Provider business mailing address

4000 WOODHAVEN ROAD
PHILADELPHIA PA
19154
US

V. Phone/Fax

Practice location:
  • Phone: 215-637-7840
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP448128
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: