Provider Demographics
NPI:1972072601
Name:PATEL, JAYESH N
Entity type:Individual
Prefix:
First Name:JAYESH
Middle Name:N
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 1:22563 WINDING WOODS WAY
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20871-3340
Mailing Address - Country:US
Mailing Address - Phone:240-644-5534
Mailing Address - Fax:
Practice Address - Street 1:WEIS PHARMACY
Practice Address - Street 2:26075 S. RIDGE RD
Practice Address - City:DAMASCUS
Practice Address - State:MD
Practice Address - Zip Code:20872
Practice Address - Country:US
Practice Address - Phone:301-253-9418
Practice Address - Fax:301-482-1179
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-26
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12282183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty