Healthcare Provider Details

I. General information

NPI: 1609293794
Provider Name (Legal Business Name): MR. CHIRAG PATEL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2014
Last Update Date: 12/25/2023
Certification Date: 12/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 9TH ST E
STEINHATCHEE FL
32359-3362
US

IV. Provider business mailing address

102 9TH ST E
STEINHATCHEE FL
32359-3362
US

V. Phone/Fax

Practice location:
  • Phone: 352-498-0680
  • Fax: 352-498-0682
Mailing address:
  • Phone: 352-498-0680
  • Fax: 352-498-0682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS43755
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: