Provider Demographics
NPI:1902401961
Name:PATEL, MOUNISH JAGADISH
Entity Type:Individual
Prefix:
First Name:MOUNISH
Middle Name:JAGADISH
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 1:2210 N FM 1417
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-3103
Mailing Address - Country:US
Mailing Address - Phone:903-209-4907
Mailing Address - Fax:903-209-4906
Practice Address - Street 1:2210 N FM 1417
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-3103
Practice Address - Country:US
Practice Address - Phone:903-209-4907
Practice Address - Fax:903-209-4906
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX57208183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist