Provider Demographics
NPI:1003135096
Name:PATEL, MITESH R (RPH)
Entity Type:Individual
Prefix:
First Name:MITESH
Middle Name:R
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 1:1301 MONUMENT RD STE 22
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-6462
Mailing Address - Country:US
Mailing Address - Phone:904-727-3434
Mailing Address - Fax:
Practice Address - Street 1:1301 MONUMENT RD STE 22
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-6462
Practice Address - Country:US
Practice Address - Phone:904-727-3434
Practice Address - Fax:904-727-3464
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-31
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26020112A183500000X
FLPS37150183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist