Provider Demographics
NPI:1326794942
Name:PATEL, PARAG
Entity Type:Individual
Prefix:
First Name:PARAG
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 1:7455 S US HIGHWAY 1 STE A
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32780-8115
Mailing Address - Country:US
Mailing Address - Phone:321-225-4833
Mailing Address - Fax:321-225-4559
Practice Address - Street 1:7455 S US HIGHWAY 1 STE A
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32780-8115
Practice Address - Country:US
Practice Address - Phone:321-225-4833
Practice Address - Fax:321-225-4559
Is Sole Proprietor?:No
Enumeration Date:2022-02-22
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS57572183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist