Provider Demographics
NPI:1063708493
Name:PATEL, RAJKUMAR (BSC)
Entity type:Individual
Prefix:MR
First Name:RAJKUMAR
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:BSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 E STATE ROAD 434 # T0649
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-5214
Mailing Address - Country:US
Mailing Address - Phone:407-332-8384
Mailing Address - Fax:
Practice Address - Street 1:130 E STATE ROAD 434
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-5214
Practice Address - Country:US
Practice Address - Phone:407-332-8384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS33057183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS33057Medicaid