MEDICARE: MR. GIRISH RASIKLAL PATEL REG.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	033494-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	033494-1	OTHER	NY	LICENSE NUMBER

General Provider Information

NPI Number	:	1932242732
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GIRISH RASIKLAL PATEL REG.PHARMACIST

Provider Business Mailing Address
First Line	:	15 ELMWOOD CT
Second Line	:
City	:	WESTBURY
State	:	NY
Zip	:	11590-1007
Country	:	US
Telephone Number	:	516-997-5798
Fax Number	:	914-664-0857

Provider Business Practice Location Address
First Line	:	105 STEVENS AVE
Second Line	:
City	:	MT VERNON
State	:	NY
Zip	:	10550-2686
Country	:	US
Telephone Number	:	914-664-0300
Fax Number	:	914-664-0857

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

Provider Enumeration Date	:	02/14/2007
Last Update Date	:	07/08/2007

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