Provider Demographics
NPI:1619257177
Name:PATEL, PATHIK
Entity Type:Individual
Prefix:
First Name:PATHIK
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 1:311 E MEMORIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33801-1766
Mailing Address - Country:US
Mailing Address - Phone:863-688-1386
Mailing Address - Fax:863-683-6170
Practice Address - Street 1:311 E MEMORIAL BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-1766
Practice Address - Country:US
Practice Address - Phone:863-688-1386
Practice Address - Fax:863-683-6170
Is Sole Proprietor?:No
Enumeration Date:2011-08-27
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS38376183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist