Provider Demographics
NPI:1972996502
Name:PATEL, HARDIK (RPH)
Entity type:Individual
Prefix:
First Name:HARDIK
Middle Name:
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 1:575 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-1934
Mailing Address - Country:US
Mailing Address - Phone:973-675-6684
Mailing Address - Fax:973-675-7589
Practice Address - Street 1:575 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-1934
Practice Address - Country:US
Practice Address - Phone:973-675-6684
Practice Address - Fax:973-675-7589
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-06
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03517300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RI03517300OtherPHARMACIST LICENSE