Provider Demographics
NPI:1750676383
Name:PATEL, JAGDISHKUMAR M
Entity Type:Individual
Prefix:MR
First Name:JAGDISHKUMAR
Middle Name:M
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 1:4003 61ST DR E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34203-7039
Mailing Address - Country:US
Mailing Address - Phone:941-404-4121
Mailing Address - Fax:941-404-4122
Practice Address - Street 1:4003 61ST DR E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34203-7039
Practice Address - Country:US
Practice Address - Phone:941-404-4121
Practice Address - Fax:941-404-4122
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-11
Last Update Date:2011-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 37291183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS 37291OtherFLORIDA STATE PHARMACIST LICENSE