1912343963 NPI number — HETAL J PATEL RPH

Table of content: HETAL J PATEL RPH (NPI 1912343963)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912343963 NPI number — HETAL J PATEL RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PATEL
Provider First Name:
HETAL
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RPH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912343963
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/17/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6 OLDE ORCHARD PARK
Provider Second Line Business Mailing Address:
APT 617
Provider Business Mailing Address City Name:
SOUTH BURLINGTON
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05403-6968
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-730-6828
Provider Business Mailing Address Fax Number:
802-864-6080

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6 OLDE ORCHARD PARK
Provider Second Line Business Practice Location Address:
APT 617
Provider Business Practice Location Address City Name:
SOUTH BURLINGTON
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05403-6968
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-730-6828
Provider Business Practice Location Address Fax Number:
802-864-6080
Provider Enumeration Date:
05/17/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  033.0003743 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 183500000X , with the licence number: 5302035457 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5302035457 . This is a "MICHIGAN BOARD OF PHARMACY PHARMACIST LICENSE NO." identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 033.0003743 . This is a "VERMONT BOARD OF PHARMACY PHARMACIST LICENSE NO." identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".




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