Provider Demographics
NPI:1194307009
Name:PATEL, ANKUR
Entity type:Individual
Prefix:
First Name:ANKUR
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 E JIMMIE LEEDS RD UNIT 1
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-9717
Mailing Address - Country:US
Mailing Address - Phone:609-748-2449
Mailing Address - Fax:609-748-0959
Practice Address - Street 1:254 E JIMMIE LEEDS RD UNIT 1
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-9717
Practice Address - Country:US
Practice Address - Phone:609-748-2449
Practice Address - Fax:609-748-0959
Is Sole Proprietor?:No
Enumeration Date:2021-04-21
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03258400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist