Provider Demographics
NPI:1609293794
Name:PATEL, CHIRAG
Entity Type:Individual
Prefix:MR
First Name:CHIRAG
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 1:102 9TH ST E
Mailing Address - Street 2:
Mailing Address - City:STEINHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:32359-3362
Mailing Address - Country:US
Mailing Address - Phone:352-498-0680
Mailing Address - Fax:352-498-0682
Practice Address - Street 1:102 9TH ST E
Practice Address - Street 2:
Practice Address - City:STEINHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:32359-3362
Practice Address - Country:US
Practice Address - Phone:352-498-0680
Practice Address - Fax:352-498-0682
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-26
Last Update Date:2023-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS43755183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003363100Medicaid
FL81-4445317Medicaid