Provider Demographics
NPI:1568635373
Name:PATEL, VIRENDRA GOPAL (RPH)
Entity Type:Individual
Prefix:MR
First Name:VIRENDRA
Middle Name:GOPAL
Last Name:PATEL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6625 IMPERIAL OAK LN
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-3567
Mailing Address - Country:US
Mailing Address - Phone:321-663-2462
Mailing Address - Fax:407-827-1947
Practice Address - Street 1:13502 S APOPKA VINELAND RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32821-6321
Practice Address - Country:US
Practice Address - Phone:407-827-1004
Practice Address - Fax:407-827-1947
Is Sole Proprietor?:No
Enumeration Date:2008-04-12
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0035535183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist