MEDICARE: INDRAVADAN 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	42927	TX

General Provider Information

NPI Number	:	1740759240
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	INDRAVADAN PATEL

Provider Business Mailing Address
First Line	:	1304 GOLDEN GATE DR
Second Line	:
City	:	SOUTHLAKE
State	:	TX
Zip	:	76092-3923
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2524 MALL CIR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76116-1545
Country	:	US
Telephone Number	:	817-737-7377
Fax Number	:

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

Provider Enumeration Date	:	11/14/2018
Last Update Date	:	11/14/2018

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Directions to “ INDRAVADAN PATEL ” Practice Location

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