Provider Demographics
NPI:1215608666
Name:DAS, NISHA PATEL (PHARMD)
Entity type:Individual
Prefix:
First Name:NISHA
Middle Name:PATEL
Last Name:DAS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 CHILD ST APT 418
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02141-1772
Mailing Address - Country:US
Mailing Address - Phone:240-422-1883
Mailing Address - Fax:
Practice Address - Street 1:13801 LONGACRES PRESERVE CT
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-6022
Practice Address - Country:US
Practice Address - Phone:240-422-1883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-24
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH240205183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist