MEDICARE: JAY PATEL

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	PS58862	FL

General Provider Information

NPI Number	:	1710577721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAY PATEL

Provider Business Mailing Address
First Line	:	1905 N NOVA RD
Second Line	:
City	:	HOLLY HILL
State	:	FL
Zip	:	32117-1421
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1905 N NOVA RD
Second Line	:
City	:	HOLLY HILL
State	:	FL
Zip	:	32117-1421
Country	:	US
Telephone Number	:	386-672-8955
Fax Number	:

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

Provider Enumeration Date	:	01/23/2021
Last Update Date	:	01/23/2021

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Directions to “ JAY PATEL ” Practice Location

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