Provider Demographics
NPI:1558966234
Name:PATEL, JAGRUTI ASHWIN
Entity Type:Individual
Prefix:
First Name:JAGRUTI
Middle Name:ASHWIN
Last Name:PATEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3411 SMART SANDS LN
Mailing Address - Street 2:
Mailing Address - City:FULSHEAR
Mailing Address - State:TX
Mailing Address - Zip Code:77441-1459
Mailing Address - Country:US
Mailing Address - Phone:713-775-7877
Mailing Address - Fax:
Practice Address - Street 1:14606 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-1513
Practice Address - Country:US
Practice Address - Phone:281-509-3440
Practice Address - Fax:281-509-3446
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50505183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist