Provider Demographics
NPI:1154585982
Name:PATEL, BALVANT R (RPH)
Entity type:Individual
Prefix:MR
First Name:BALVANT
Middle Name:R
Last Name:PATEL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6010A KISSENA BLVD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-5548
Mailing Address - Country:US
Mailing Address - Phone:718-445-8450
Mailing Address - Fax:718-445-8450
Practice Address - Street 1:6010A KISSENA BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-5548
Practice Address - Country:US
Practice Address - Phone:718-445-8450
Practice Address - Fax:718-445-8450
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051341183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist