Provider Demographics
NPI:1821688599
Name:PATEL, AMIT H (RPH)
Entity Type:Individual
Prefix:MR
First Name:AMIT
Middle Name:H
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 1:7 DOUBLE PALM WAY
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-1864
Mailing Address - Country:US
Mailing Address - Phone:732-521-2085
Mailing Address - Fax:
Practice Address - Street 1:1891 LPGA BLVD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-7108
Practice Address - Country:US
Practice Address - Phone:386-274-1490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02068600183500000X
FLPS34129183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist