Healthcare Provider Details

I. General information

NPI: 1679163893
Provider Name (Legal Business Name): AMIT M PATEL PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2021
Last Update Date: 01/21/2021
Certification Date: 01/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MUNDO RD
DULCE NM
87528
US

IV. Provider business mailing address

1910 WYSTER DR
GARLAND TX
75040-4587
US

V. Phone/Fax

Practice location:
  • Phone: 575-759-3291
  • Fax:
Mailing address:
  • Phone: 214-208-6218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number65504
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: