Provider Demographics
NPI:1154604270
Name:PATEL, MITESH S (RPH)
Entity type:Individual
Prefix:
First Name:MITESH
Middle Name:S
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 1:131 THIRD ST
Mailing Address - Street 2:
Mailing Address - City:AYDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28513-7252
Mailing Address - Country:US
Mailing Address - Phone:252-746-3126
Mailing Address - Fax:252-746-2319
Practice Address - Street 1:131 THIRD ST
Practice Address - Street 2:
Practice Address - City:AYDEN
Practice Address - State:NC
Practice Address - Zip Code:28513-7252
Practice Address - Country:US
Practice Address - Phone:252-746-3126
Practice Address - Fax:252-746-2319
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-25
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18803183500000X
NJ28RI03256600183500000X
NC28528183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD18803OtherTHE MARYLAND STATE BOARD OF PHARMACY
NJ28RI03256600OtherNEW JERSEY BOARD OF PHARMACY