Provider Demographics
NPI:1851876080
Name:PATEL, NITA A
Entity Type:Individual
Prefix:MRS
First Name:NITA
Middle Name:A
Last Name:PATEL
Suffix:
Gender:F
Credentials:
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:732-685-1694
Mailing Address - Fax:
Practice Address - Street 1:1569 SAXON BLVD
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-5833
Practice Address - Country:US
Practice Address - Phone:386-457-6190
Practice Address - Fax:386-457-6187
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-03
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS34130183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist