Provider Demographics
NPI:1225403553
Name:PATEL, KUNJAL
Entity Type:Individual
Prefix:
First Name:KUNJAL
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16640 S US HIGHWAY 301 STE 103
Mailing Address - Street 2:
Mailing Address - City:WIMAUMA
Mailing Address - State:FL
Mailing Address - Zip Code:33598-4006
Mailing Address - Country:US
Mailing Address - Phone:813-812-6062
Mailing Address - Fax:813-200-3130
Practice Address - Street 1:16640 S US HIGHWAY 301 STE 103
Practice Address - Street 2:
Practice Address - City:WIMAUMA
Practice Address - State:FL
Practice Address - Zip Code:33598-4006
Practice Address - Country:US
Practice Address - Phone:813-812-6062
Practice Address - Fax:813-200-3130
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-11
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS58332183500000X
IL051298410183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist