Provider Demographics
NPI:1841877784
Name:PATEL, PRANAVKUMAR K (RPH)
Entity type:Individual
Prefix:
First Name:PRANAVKUMAR
Middle Name:K
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 1:14306D N DALE MABRY HWY STE D
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-2018
Mailing Address - Country:US
Mailing Address - Phone:813-963-6800
Mailing Address - Fax:813-963-6889
Practice Address - Street 1:14306D N DALE MABRY HWY STE D
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2018
Practice Address - Country:US
Practice Address - Phone:813-963-6800
Practice Address - Fax:813-963-6889
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-26
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS57788183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist