Provider Demographics
NPI:1750405361
Name:PATEL, RAKESH R (RPH)
Entity type:Individual
Prefix:MR
First Name:RAKESH
Middle Name:R
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 1:200 ORISKANY BLVD
Mailing Address - Street 2:C O THE MEDICINE SHOPPE
Mailing Address - City:YORKVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13495-1330
Mailing Address - Country:US
Mailing Address - Phone:315-768-3347
Mailing Address - Fax:315-768-7721
Practice Address - Street 1:200 ORISKANY BLVD
Practice Address - Street 2:
Practice Address - City:YORKVILLE
Practice Address - State:NY
Practice Address - Zip Code:13495-1330
Practice Address - Country:US
Practice Address - Phone:315-768-3347
Practice Address - Fax:315-768-7721
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038793183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist