MEDICARE: SUKETU PATEL RPH

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	051031	NY
2	183500000X	Pharmacist	2791500	NJ

General Provider Information

NPI Number	:	1144476763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUKETU PATEL RPH

Provider Business Mailing Address
First Line	:	35 LUCILLE CT
Second Line	:
City	:	PISCATAWAY
State	:	NJ
Zip	:	08854-2865
Country	:	US
Telephone Number	:	732-529-6194
Fax Number	:

Provider Business Practice Location Address
First Line	:	1817 HYLAN BLVD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10305-1918
Country	:	US
Telephone Number	:	718-987-2525
Fax Number	:

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

Provider Enumeration Date	:	08/14/2008
Last Update Date	:	08/14/2008

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Directions to “ SUKETU PATEL RPH” Practice Location

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