MEDICARE: RICHA K PATEL PHARMACIST

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	056468	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	056468	OTHER	NY	NEW YORK STATE LICENSE

General Provider Information

NPI Number	:	1669740999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHA K PATEL PHARMACIST

Provider Business Mailing Address
First Line	:	8723 144TH ST
Second Line	:
City	:	JAMAICA
State	:	NY
Zip	:	11435-3121
Country	:	US
Telephone Number	:	917-392-5579
Fax Number	:

Provider Business Practice Location Address
First Line	:	1368 LINDEN BLVD
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11212-4702
Country	:	US
Telephone Number	:	718-342-3131
Fax Number	:	718-569-0073

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

Provider Enumeration Date	:	12/01/2011
Last Update Date	:	12/01/2011

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