Provider Demographics
NPI:1740619832
Name:PATEL, VIPULKUMAR (RPH)
Entity Type:Individual
Prefix:MR
First Name:VIPULKUMAR
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 1:101 S PARK AVE
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-4254
Mailing Address - Country:US
Mailing Address - Phone:407-703-5951
Mailing Address - Fax:407-703-5950
Practice Address - Street 1:101 S PARK AVE
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-4254
Practice Address - Country:US
Practice Address - Phone:407-703-5951
Practice Address - Fax:407-703-5950
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-08
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS38411183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS38411OtherLICENSE