MEDICARE: MR. JAIMIN 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	2013020882	MO

General Provider Information

NPI Number	:	1538509310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAIMIN PATEL PHARM.D.

Provider Business Mailing Address
First Line	:	3881 MEXICO RD
Second Line	:	T-1280
City	:	SAINT CHARLES
State	:	MO
Zip	:	63303-3042
Country	:	US
Telephone Number	:	636-922-3064
Fax Number	:	636-866-0542

Provider Business Practice Location Address
First Line	:	3881 MEXICO RD
Second Line	:	T-1280
City	:	SAINT CHARLES
State	:	MO
Zip	:	63303-3042
Country	:	US
Telephone Number	:	636-922-3064
Fax Number	:	636-866-0542

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

Provider Enumeration Date	:	06/26/2013
Last Update Date	:	06/26/2013

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