Provider Demographics
NPI:1104344712
Name:PATEL, JAY (PHARMACIST)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6410 I-45
Mailing Address - Street 2:
Mailing Address - City:LAMARQUE
Mailing Address - State:TX
Mailing Address - Zip Code:77568
Mailing Address - Country:US
Mailing Address - Phone:409-986-7726
Mailing Address - Fax:
Practice Address - Street 1:6410 I-45 (WALMART PHARMACY)
Practice Address - Street 2:
Practice Address - City:LAMARQUE
Practice Address - State:TX
Practice Address - Zip Code:77568
Practice Address - Country:US
Practice Address - Phone:409-986-7726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-03
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX56802183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist