Provider Demographics
NPI:1649800376
Name:PATA, JOSEPH A
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:A
Last Name:PATA
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 1:8320 43RD AVENUE DR W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-6418
Mailing Address - Country:US
Mailing Address - Phone:941-356-0512
Mailing Address - Fax:
Practice Address - Street 1:4150 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34293-5130
Practice Address - Country:US
Practice Address - Phone:941-493-1502
Practice Address - Fax:941-497-1082
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS25314183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist