=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083963615
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KHILNA PATEL
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/29/2012
-----------------------------------------------------
Last Update Date | 08/29/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 360 STAR ST
-----------------------------------------------------
City | EAST MEADOW
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11554-3307
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-981-3459
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 360 STAR ST
-----------------------------------------------------
City | EAST MEADOW
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11554-3307
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-981-3459
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 057015
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------