Provider Demographics
NPI:1063750453
Name:PATEL, KUNTAL (RPH)
Entity type:Individual
Prefix:
First Name:KUNTAL
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5371 EHRLICH RD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33625-5508
Mailing Address - Country:US
Mailing Address - Phone:813-962-0870
Mailing Address - Fax:813-961-8495
Practice Address - Street 1:5371 EHRLICH RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33625-5508
Practice Address - Country:US
Practice Address - Phone:813-962-0870
Practice Address - Fax:813-961-8495
Is Sole Proprietor?:No
Enumeration Date:2013-01-21
Last Update Date:2013-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS37961183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist