Provider Demographics
NPI:1396390894
Name:PATEL, DEVANG BHARATBHAI
Entity Type:Individual
Prefix:
First Name:DEVANG
Middle Name:BHARATBHAI
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 1:407 S PARROTT AVE
Mailing Address - Street 2:
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34974-4342
Mailing Address - Country:US
Mailing Address - Phone:863-763-7633
Mailing Address - Fax:863-763-7666
Practice Address - Street 1:407 S PARROTT AVE
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34974-4342
Practice Address - Country:US
Practice Address - Phone:863-763-7633
Practice Address - Fax:863-763-7666
Is Sole Proprietor?:No
Enumeration Date:2019-08-02
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS59604183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist