Provider Demographics
NPI:1821275199
Name:PATEL, PRITIBEN MOHAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:PRITIBEN
Middle Name:MOHAN
Last Name:PATEL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1472 VIA SANGRO PL
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-6243
Mailing Address - Country:US
Mailing Address - Phone:407-617-6738
Mailing Address - Fax:
Practice Address - Street 1:263 WINDING HOLLOW BLVD STE 1005
Practice Address - Street 2:
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-4035
Practice Address - Country:US
Practice Address - Phone:610-834-1122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-29
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53409183500000X
SC9572183500000X
FLPS41213183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist