Provider Demographics
NPI:1871891028
Name:PATEL, JIGNESHKUMAR TRIBHOVANDAS
Entity type:Individual
Prefix:
First Name:JIGNESHKUMAR
Middle Name:TRIBHOVANDAS
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:JIGNESH
Other - Middle Name:TRIBHOVANBHAI
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1630 BENVENUE RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-6344
Mailing Address - Country:US
Mailing Address - Phone:252-977-2616
Mailing Address - Fax:252-977-0008
Practice Address - Street 1:1630 BENVENUE RD
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-6344
Practice Address - Country:US
Practice Address - Phone:252-977-2616
Practice Address - Fax:252-977-0008
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-10
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20144183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist