Provider Demographics
NPI:1114249927
Name:PATEL, MANISH H (RPH)
Entity Type:Individual
Prefix:
First Name:MANISH
Middle Name:H
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 1:815 BEVILLE RD
Mailing Address - Street 2:SUITE#D
Mailing Address - City:SOUTH DAYTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32119-1858
Mailing Address - Country:US
Mailing Address - Phone:386-322-5969
Mailing Address - Fax:386-322-0626
Practice Address - Street 1:815 BEVILLE RD
Practice Address - Street 2:SUITE#D
Practice Address - City:SOUTH DAYTONA
Practice Address - State:FL
Practice Address - Zip Code:32119-1858
Practice Address - Country:US
Practice Address - Phone:386-322-5969
Practice Address - Fax:386-322-0626
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-20
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH23268183500000X
FLPS37317183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist