Provider Demographics
NPI:1851966493
Name:PATEL, ROSHAN J (RPH)
Entity Type:Individual
Prefix:DR
First Name:ROSHAN
Middle Name:J
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 1:470 HIGHWAY 90 E
Mailing Address - Street 2:
Mailing Address - City:SEALY
Mailing Address - State:TX
Mailing Address - Zip Code:77474-4104
Mailing Address - Country:US
Mailing Address - Phone:979-472-0637
Mailing Address - Fax:
Practice Address - Street 1:470 HIGHWAY 90 E
Practice Address - Street 2:
Practice Address - City:SEALY
Practice Address - State:TX
Practice Address - Zip Code:77474-4104
Practice Address - Country:US
Practice Address - Phone:979-472-0637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68251183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist