Provider Demographics
NPI:1104420322
Name:PATEL, VRUNDA (PHARMD)
Entity type:Individual
Prefix:
First Name:VRUNDA
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:VRUNDA
Other - Middle Name:
Other - Last Name:THALLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:12903 BOVET AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827-7707
Mailing Address - Country:US
Mailing Address - Phone:815-701-6945
Mailing Address - Fax:
Practice Address - Street 1:10425 NARCOOSSEE RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832-6902
Practice Address - Country:US
Practice Address - Phone:407-384-9353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-29
Last Update Date:2020-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS54467183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist