Provider Demographics
NPI:1235689092
Name:PATTANI, DEEPA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DEEPA
Middle Name:
Last Name:PATTANI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 W MCDERMOTT DR
Mailing Address - Street 2:STE: 116-191
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-6510
Mailing Address - Country:US
Mailing Address - Phone:972-372-9775
Mailing Address - Fax:
Practice Address - Street 1:906 W MCDERMOTT DR
Practice Address - Street 2:STE: 116-191
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-6510
Practice Address - Country:US
Practice Address - Phone:972-372-9775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-05
Last Update Date:2019-01-18
Deactivation Date:2018-09-24
Deactivation Code:
Reactivation Date:2019-01-18
Provider Licenses
StateLicense IDTaxonomies
TX57533183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist