MEDICARE: KHILNA PATEL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	057015	NY

General Provider Information

NPI Number	:	1083963615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KHILNA PATEL

Provider Business Mailing Address
First Line	:	360 STAR ST
Second Line	:
City	:	EAST MEADOW
State	:	NY
Zip	:	11554-3307
Country	:	US
Telephone Number	:	646-981-3459
Fax Number	:

Provider Business Practice Location Address
First Line	:	360 STAR ST
Second Line	:
City	:	EAST MEADOW
State	:	NY
Zip	:	11554-3307
Country	:	US
Telephone Number	:	646-981-3459
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2012
Last Update Date	:	08/29/2012

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