Provider Demographics
NPI:1700975646
Name:PATEL, BHUPENDRA M (RPH)
Entity Type:Individual
Prefix:MR
First Name:BHUPENDRA
Middle Name:M
Last Name:PATEL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18205 BITTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-2734
Mailing Address - Country:US
Mailing Address - Phone:813-963-6025
Mailing Address - Fax:813-963-6379
Practice Address - Street 1:14936 N FLORIDA AVE
Practice Address - Street 2:THE MEDICINE SHOPPE PHARMACY
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-1626
Practice Address - Country:US
Practice Address - Phone:813-961-6546
Practice Address - Fax:813-963-6379
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS30767183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS30767OtherPHARMACIST LICENSE