Provider Demographics
NPI:1285262113
Name:PATEL, VIJAY B
Entity type:Individual
Prefix:
First Name:VIJAY
Middle Name:B
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6132 MERRILL RD STE 12
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32277-3489
Mailing Address - Country:US
Mailing Address - Phone:904-683-7059
Mailing Address - Fax:904-813-7934
Practice Address - Street 1:6132 MERRILL RD STE 12
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32277-3489
Practice Address - Country:US
Practice Address - Phone:904-683-7059
Practice Address - Fax:904-813-7934
Is Sole Proprietor?:No
Enumeration Date:2020-03-27
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS34212183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist