Provider Demographics
NPI:1518561554
Name:PATEL, PRAFUL
Entity Type:Individual
Prefix:
First Name:PRAFUL
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 1:2961 DUFF RD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33810-2188
Mailing Address - Country:US
Mailing Address - Phone:863-738-2729
Mailing Address - Fax:863-808-1797
Practice Address - Street 1:2961 DUFF RD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33810-2188
Practice Address - Country:US
Practice Address - Phone:863-738-2729
Practice Address - Fax:863-808-1797
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS37401183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL113153600Medicaid