Provider Demographics
NPI:1689969248
Name:PATEL, SANJAY (RPH)
Entity Type:Individual
Prefix:
First Name:SANJAY
Middle Name:
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 1:3770 N GOLDENROD RD
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-8832
Mailing Address - Country:US
Mailing Address - Phone:407-670-0389
Mailing Address - Fax:407-671-2080
Practice Address - Street 1:3770 N GOLDENROD RD
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-8832
Practice Address - Country:US
Practice Address - Phone:407-670-0389
Practice Address - Fax:407-671-2080
Is Sole Proprietor?:No
Enumeration Date:2011-06-12
Last Update Date:2011-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS27418183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist