Provider Demographics
NPI:1568731727
Name:PATEL, VIPUL D
Entity Type:Individual
Prefix:
First Name:VIPUL
Middle Name:D
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 1:8265 CHAMPIONS GATE BLVD
Mailing Address - Street 2:
Mailing Address - City:CHAMPIONS GATE
Mailing Address - State:FL
Mailing Address - Zip Code:33896-8387
Mailing Address - Country:US
Mailing Address - Phone:321-677-0487
Mailing Address - Fax:
Practice Address - Street 1:8265 CHAMPIONS GATE BLVD
Practice Address - Street 2:
Practice Address - City:CHAMPIONS GATE
Practice Address - State:FL
Practice Address - Zip Code:33896-8387
Practice Address - Country:US
Practice Address - Phone:321-677-0487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-17
Last Update Date:2011-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS37369183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist