Provider Demographics
NPI:1598282733
Name:PATEL, DIVYESH N (RPH)
Entity Type:Individual
Prefix:
First Name:DIVYESH
Middle Name:N
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 1:8875 HIGHWAY 279
Mailing Address - Street 2:
Mailing Address - City:BROWNWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76801-0012
Mailing Address - Country:US
Mailing Address - Phone:843-337-7818
Mailing Address - Fax:
Practice Address - Street 1:200 W COMMERCE ST
Practice Address - Street 2:
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801-1806
Practice Address - Country:US
Practice Address - Phone:325-646-8923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-28
Last Update Date:2017-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61362183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist