MEDICARE: MR. VIRENDRA 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	030969	NY

General Provider Information

NPI Number	:	1861715989
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. VIRENDRA D PATEL RPH

Provider Business Mailing Address
First Line	:	16 4TH AVE
Second Line	:
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11040-5009
Country	:	US
Telephone Number	:	914-668-9300
Fax Number	:	914-668-9311

Provider Business Practice Location Address
First Line	:	11 S 4TH AVE
Second Line	:
City	:	MOUNT VERNON
State	:	NY
Zip	:	10550-3104
Country	:	US
Telephone Number	:	914-668-9300
Fax Number	:	914-668-9311

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

Provider Enumeration Date	:	03/03/2010
Last Update Date	:	03/03/2010

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