Healthcare Provider Details

I. General information

NPI: 1811994320
Provider Name (Legal Business Name): NIMA M PATEL-SHORI PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 N BROAD ST
PHILADELPHIA PA
19140-5103
US

IV. Provider business mailing address

3307 N BROAD ST
PHILADELPHIA PA
19140-5101
US

V. Phone/Fax

Practice location:
  • Phone: 215-707-3416
  • Fax: 215-707-6862
Mailing address:
  • Phone: 215-707-2319
  • Fax: 215-707-8326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberRP438240
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: