Provider Demographics
NPI:1184930307
Name:PATWA, PAYAL (PHARMD)
Entity type:Individual
Prefix:MS
First Name:PAYAL
Middle Name:
Last Name:PATWA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5600 SOUTH 1ST STREET
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-7970
Mailing Address - Country:US
Mailing Address - Phone:512-441-4747
Mailing Address - Fax:
Practice Address - Street 1:5600 S 1ST ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-3108
Practice Address - Country:US
Practice Address - Phone:512-441-4747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-25
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX48879183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist