Provider Demographics
NPI:1235416876
Name:PATEL, AMIT M (PHARMD)
Entity Type:Individual
Prefix:
First Name:AMIT
Middle Name:M
Last Name:PATEL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 CLARIDEN RANCH RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-1976
Mailing Address - Country:US
Mailing Address - Phone:505-710-1260
Mailing Address - Fax:
Practice Address - Street 1:10001 N MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-5002
Practice Address - Country:US
Practice Address - Phone:972-501-9202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-10
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50913183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist