=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063022390
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KUNAL PATEL PHARMD.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/02/2020
-----------------------------------------------------
Last Update Date | 08/02/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 438 ROUTE 206 STE 3
-----------------------------------------------------
City | HILLSBOROUGH
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08844-5525
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-829-3431
-----------------------------------------------------
Fax | 908-829-4316
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 438 ROUTE 206 STE 3
-----------------------------------------------------
City | HILLSBOROUGH
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08844-5525
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-829-3431
-----------------------------------------------------
Fax | 908-829-4316
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 28RI03598200
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------