Provider Demographics
NPI:1164008413
Name:PATEL, ANAND (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:ANAND
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21340 GERTRUDE AVE
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-5018
Mailing Address - Country:US
Mailing Address - Phone:941-625-7800
Mailing Address - Fax:941-625-7812
Practice Address - Street 1:21340 GERTRUDE AVE
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-5018
Practice Address - Country:US
Practice Address - Phone:941-625-7800
Practice Address - Fax:941-625-7812
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-18
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS37194183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist