Provider Demographics
NPI:1366734857
Name:PATEL, PURVISH P
Entity type:Individual
Prefix:
First Name:PURVISH
Middle Name:P
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 1:791 SCRANTON CARBONDALE HWY
Mailing Address - Street 2:
Mailing Address - City:EYNON
Mailing Address - State:PA
Mailing Address - Zip Code:18403-1021
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:570-876-8201
Practice Address - Street 1:791 SCRANTON CARBONDALE HWY
Practice Address - Street 2:
Practice Address - City:EYNON
Practice Address - State:PA
Practice Address - Zip Code:18403-1021
Practice Address - Country:US
Practice Address - Phone:570-876-3788
Practice Address - Fax:570-876-8201
Is Sole Proprietor?:No
Enumeration Date:2011-05-03
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP439767183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist