Provider Demographics
NPI:1942576202
Name:PATEL, RAJDEEP
Entity Type:Individual
Prefix:
First Name:RAJDEEP
Middle Name:
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 1:6229 14TH ST W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34207-4611
Mailing Address - Country:US
Mailing Address - Phone:941-753-6075
Mailing Address - Fax:941-753-1417
Practice Address - Street 1:6229 14TH ST W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-4611
Practice Address - Country:US
Practice Address - Phone:941-753-6075
Practice Address - Fax:941-753-1417
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS38192183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS38192OtherSTATE LICENSE