Provider Demographics
NPI:1013560762
Name:PATEL, GOPI
Entity Type:Individual
Prefix:
First Name:GOPI
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 S PARSONS AVE UNIT 104
Mailing Address - Street 2:
Mailing Address - City:SEFFNER
Mailing Address - State:FL
Mailing Address - Zip Code:33584-7201
Mailing Address - Country:US
Mailing Address - Phone:813-685-4444
Mailing Address - Fax:
Practice Address - Street 1:1812 S PARSONS AVE UNIT 104
Practice Address - Street 2:
Practice Address - City:SEFFNER
Practice Address - State:FL
Practice Address - Zip Code:33584-7201
Practice Address - Country:US
Practice Address - Phone:813-685-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-22
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS59170183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist