Provider Demographics
NPI:1588970552
Name:PATEL, MIRA M (BPHARM)
Entity type:Individual
Prefix:
First Name:MIRA
Middle Name:M
Last Name:PATEL
Suffix:
Gender:F
Credentials:BPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7270 MONTGOMERY ROAD
Mailing Address - Street 2:RITE AID PHARMACY
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075
Mailing Address - Country:US
Mailing Address - Phone:410-796-3344
Mailing Address - Fax:410-796-2367
Practice Address - Street 1:7270 MONTGOMERY ROAD
Practice Address - Street 2:RITE AID PHARMACY
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075
Practice Address - Country:US
Practice Address - Phone:410-796-3344
Practice Address - Fax:410-796-2367
Is Sole Proprietor?:No
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14031183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist