Provider Demographics
NPI:1255931176
Name:PATEL, KEVIN K (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:K
Last Name:PATEL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 S JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32348-5615
Mailing Address - Country:US
Mailing Address - Phone:850-223-4189
Mailing Address - Fax:850-223-4192
Practice Address - Street 1:1900 S JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:FL
Practice Address - Zip Code:32348-5615
Practice Address - Country:US
Practice Address - Phone:850-223-4189
Practice Address - Fax:850-223-4192
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH028329183500000X
FLPS52274183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist