Provider Demographics
NPI:1841812112
Name:PATEL, AJAYKUMAR R (PHARMD)
Entity type:Individual
Prefix:
First Name:AJAYKUMAR
Middle Name:R
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 1:3232 PLAYERS VIEW CIR
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-3154
Mailing Address - Country:US
Mailing Address - Phone:732-912-8122
Mailing Address - Fax:
Practice Address - Street 1:3232 PLAYERS VIEW CIR
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-3154
Practice Address - Country:US
Practice Address - Phone:732-912-8122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-10
Last Update Date:2020-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS56001183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist