MEDICARE: NISHMA PATEL PHARM. D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PS54382	FL

General Provider Information

NPI Number	:	1366803900
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NISHMA PATEL PHARM. D.

Provider Business Mailing Address
First Line	:	12231 E COLONIAL DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32826-4759
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12231 E COLONIAL DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32826-4759
Country	:	US
Telephone Number	:	407-482-1384
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2016
Last Update Date	:	03/10/2016

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