Provider Demographics
NPI:1679123137
Name:PATEL, NICKHIL BHAVESH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NICKHIL
Middle Name:BHAVESH
Last Name:PATEL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10971 SAVANNAH LANDING CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-5104
Mailing Address - Country:US
Mailing Address - Phone:321-482-1901
Mailing Address - Fax:
Practice Address - Street 1:3839 PLEASANT HILL RD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-2952
Practice Address - Country:US
Practice Address - Phone:407-343-7878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-17
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS59659183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist