MEDICARE: PRANAVKUMAR K PATEL RPH

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	PS57788	FL

General Provider Information

NPI Number	:	1841877784
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRANAVKUMAR K PATEL RPH

Provider Business Mailing Address
First Line	:	14306D N DALE MABRY HWY STE D
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-2018
Country	:	US
Telephone Number	:	813-963-6800
Fax Number	:	813-963-6889

Provider Business Practice Location Address
First Line	:	14306D N DALE MABRY HWY STE D
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-2018
Country	:	US
Telephone Number	:	813-963-6800
Fax Number	:	813-963-6889

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

Provider Enumeration Date	:	03/26/2021
Last Update Date	:	03/26/2021

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