Provider Demographics
NPI:1487961819
Name:PATEL, VIRAL
Entity type:Individual
Prefix:
First Name:VIRAL
Middle Name:
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 1:15511 N FLORIDA AVE
Mailing Address - Street 2:SUITE C-2
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-1263
Mailing Address - Country:US
Mailing Address - Phone:813-961-2400
Mailing Address - Fax:813-961-2424
Practice Address - Street 1:15511 N FLORIDA AVE
Practice Address - Street 2:SUITE C-2
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-1263
Practice Address - Country:US
Practice Address - Phone:813-961-2400
Practice Address - Fax:813-961-2424
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-07
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS37344183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist