Provider Demographics
NPI:1740723378
Name:PATEL, KALPENDRA
Entity type:Individual
Prefix:
First Name:KALPENDRA
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 1:1624 CAPITAL CIRCLE NE
Mailing Address - Street 2:STE 210
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308
Mailing Address - Country:US
Mailing Address - Phone:850-765-4026
Mailing Address - Fax:850-765-4028
Practice Address - Street 1:1624 CAPITAL CIRCLE NE
Practice Address - Street 2:STE 210
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308
Practice Address - Country:US
Practice Address - Phone:850-765-4026
Practice Address - Fax:850-765-4028
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-30
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS55597183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist