MEDICARE: CHIRAG D 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	28RI02998600	NJ

General Provider Information

NPI Number	:	1548687247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHIRAG D PATEL RPH

Provider Business Mailing Address
First Line	:	168 LEE ST
Second Line	:
City	:	ELMWOOD PARK
State	:	NJ
Zip	:	07407-2211
Country	:	US
Telephone Number	:	862-215-5208
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 LOCUST AVENUE
Second Line	:
City	:	WALLINGTON
State	:	NJ
Zip	:	07057-2102
Country	:	US
Telephone Number	:	973-777-4717
Fax Number	:	973-777-4719

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

Provider Enumeration Date	:	03/20/2014
Last Update Date	:	02/02/2017

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