MEDICARE: PRIYANKA PATEL

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	23081	NC
2	183500000X	Pharmacist	28RI03544800	NJ

General Provider Information

NPI Number	:	1992121230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRIYANKA PATEL

Provider Business Mailing Address
First Line	:	308 N CAROLINA 55 WEST
Second Line	:
City	:	MOUNT OLIVE
State	:	NC
Zip	:	28365-1105
Country	:	US
Telephone Number	:	919-658-2608
Fax Number	:

Provider Business Practice Location Address
First Line	:	308 NORTH CAROLINA 55 WEST
Second Line	:
City	:	MOUNT OLIVE
State	:	NC
Zip	:	28365-1105
Country	:	US
Telephone Number	:	919-658-2608
Fax Number	:	919-658-2807

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

Provider Enumeration Date	:	03/11/2014
Last Update Date	:	03/11/2014

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Directions to “ PRIYANKA PATEL ” Practice Location

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