Provider Demographics
NPI:1538451117
Name:PATEL, NIMESH
Entity type:Individual
Prefix:
First Name:NIMESH
Middle Name:
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 1:8642 ASH LN
Mailing Address - Street 2:
Mailing Address - City:BREINIGSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18031-1264
Mailing Address - Country:US
Mailing Address - Phone:484-274-5192
Mailing Address - Fax:
Practice Address - Street 1:480 W BERTSCH ST
Practice Address - Street 2:
Practice Address - City:LANSFORD
Practice Address - State:PA
Practice Address - Zip Code:18232-1003
Practice Address - Country:US
Practice Address - Phone:570-645-3179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-13
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP440841183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist