Provider Demographics
NPI:1437658895
Name:PANCHAL, NIKUL R
Entity Type:Individual
Prefix:
First Name:NIKUL
Middle Name:R
Last Name:PANCHAL
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 1:19126 WOOD SAGE DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-3093
Mailing Address - Country:US
Mailing Address - Phone:813-482-7700
Mailing Address - Fax:
Practice Address - Street 1:6308 BENJAMIN RD STE 709
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-5174
Practice Address - Country:US
Practice Address - Phone:727-896-0001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-12
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS35632183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist