Provider Demographics
NPI:1861715989
Name:PATEL, VIRENDRA D (RPH)
Entity type:Individual
Prefix:MR
First Name:VIRENDRA
Middle Name:D
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 1:16 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-5009
Mailing Address - Country:US
Mailing Address - Phone:914-668-9300
Mailing Address - Fax:914-668-9311
Practice Address - Street 1:11 S 4TH AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-3104
Practice Address - Country:US
Practice Address - Phone:914-668-9300
Practice Address - Fax:914-668-9311
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-03
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030969183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist