Provider Demographics
NPI:1306128335
Name:PATEL, MANISH ARVIND (RPH)
Entity type:Individual
Prefix:
First Name:MANISH
Middle Name:ARVIND
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 1:597 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-3333
Mailing Address - Country:US
Mailing Address - Phone:973-450-0138
Mailing Address - Fax:973-450-5970
Practice Address - Street 1:597 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-3333
Practice Address - Country:US
Practice Address - Phone:973-450-0138
Practice Address - Fax:973-450-5970
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02808800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist