Provider Demographics
NPI:1932593183
Name:PATEL, BHAVESH
Entity Type:Individual
Prefix:
First Name:BHAVESH
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 1:2480 13TH AVE N
Mailing Address - Street 2:APT#110
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-5853
Mailing Address - Country:US
Mailing Address - Phone:863-634-9167
Mailing Address - Fax:
Practice Address - Street 1:2480 13TH AVE N
Practice Address - Street 2:APT#110
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-5853
Practice Address - Country:US
Practice Address - Phone:863-634-9167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-26
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPSI 28322183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist