Provider Demographics
NPI:1992115588
Name:PATEL, AMBRISH (PHARMD)
Entity type:Individual
Prefix:DR
First Name:AMBRISH
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 E PINE ST
Mailing Address - Street 2:KMART PHARNACY
Mailing Address - City:DEMING
Mailing Address - State:NM
Mailing Address - Zip Code:88030-7038
Mailing Address - Country:US
Mailing Address - Phone:575-544-9008
Mailing Address - Fax:575-544-4465
Practice Address - Street 1:190 THOMAS JOHNSON DR STE 3
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4879
Practice Address - Country:US
Practice Address - Phone:240-422-8433
Practice Address - Fax:301-662-0001
Is Sole Proprietor?:No
Enumeration Date:2014-05-05
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00007752183500000X
TX50775183500000X
MD24518183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist