Provider Demographics
NPI:1447842489
Name:PATEL, AVANI
Entity type:Individual
Prefix:
First Name:AVANI
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 NEWTONS CORNER RD
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07731-2890
Mailing Address - Country:US
Mailing Address - Phone:551-580-8122
Mailing Address - Fax:732-840-5880
Practice Address - Street 1:145 NEWTONS CORNER RD
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:NJ
Practice Address - Zip Code:07731-2890
Practice Address - Country:US
Practice Address - Phone:551-580-8122
Practice Address - Fax:732-840-5880
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03669800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty