Provider Demographics
NPI:1154414175
Name:PATEL, VIPUL A (PHARMD,BCP,CGP)
Entity type:Individual
Prefix:DR
First Name:VIPUL
Middle Name:A
Last Name:PATEL
Suffix:
Gender:M
Credentials:PHARMD,BCP,CGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 PRISCILLA LN
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-4219
Mailing Address - Country:US
Mailing Address - Phone:631-609-0587
Mailing Address - Fax:
Practice Address - Street 1:11 PRISCILLA LN
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-4219
Practice Address - Country:US
Practice Address - Phone:631-609-0587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI030572001835P1200X, 1835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No1835G0303XPharmacy Service ProvidersPharmacistGeriatric