Provider Demographics
NPI:1366620544
Name:PATEL, JESIKA (RPH)
Entity type:Individual
Prefix:MRS
First Name:JESIKA
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 CLUBHOUSE LN
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-2264
Mailing Address - Country:US
Mailing Address - Phone:302-475-2606
Mailing Address - Fax:302-475-2606
Practice Address - Street 1:2105 PHILADELPHIA PIKE
Practice Address - Street 2:
Practice Address - City:CLAYMONT
Practice Address - State:DE
Practice Address - Zip Code:19703-2426
Practice Address - Country:US
Practice Address - Phone:302-798-4618
Practice Address - Fax:302-798-4632
Is Sole Proprietor?:No
Enumeration Date:2008-02-10
Last Update Date:2008-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0003681183500000X
PARP442310183500000X
NJ28RI02743000183500000X
VA0202205081183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEA1-0003681OtherPHARMACIST
VA0202205081OtherPHARMACIST
NJ28RI02743000OtherPHARMACIST
PARP442310OtherPHARMACIST