Healthcare Provider Details

I. General information

NPI: 1578229290
Provider Name (Legal Business Name): RAJESH PATEL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2021
Last Update Date: 05/10/2022
Certification Date: 05/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10226 GARDEN ALCOVE DR
TAMPA FL
33647-3117
US

IV. Provider business mailing address

10226 GARDEN ALCOVE DR
TAMPA FL
33647-3117
US

V. Phone/Fax

Practice location:
  • Phone: 813-971-8401
  • Fax: 813-971-8708
Mailing address:
  • Phone: 813-971-8401
  • Fax: 813-971-8708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS32149
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: