Provider Demographics
NPI:1396026621
Name:PATEL, BHUPENDRA
Entity Type:Individual
Prefix:
First Name:BHUPENDRA
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 1:2941 VINTAGE VIEW CIR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33812-5061
Mailing Address - Country:US
Mailing Address - Phone:863-607-9805
Mailing Address - Fax:863-607-9805
Practice Address - Street 1:4340 S FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-1631
Practice Address - Country:US
Practice Address - Phone:863-644-7549
Practice Address - Fax:863-619-6185
Is Sole Proprietor?:No
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY013126183500000X
MI5302036721183500000X
FLPS37125183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist