Provider Demographics
NPI:1386913812
Name:PATEL, DIPAL V (RPH)
Entity type:Individual
Prefix:MR
First Name:DIPAL
Middle Name:V
Last Name:PATEL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15202 OCTAVIA LN
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-1403
Mailing Address - Country:US
Mailing Address - Phone:813-210-5243
Mailing Address - Fax:813-662-2263
Practice Address - Street 1:1860 E FOWLER AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-5511
Practice Address - Country:US
Practice Address - Phone:813-977-0651
Practice Address - Fax:813-632-8030
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-29
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS36314183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist