Healthcare Provider Details

I. General information

NPI: 1194053405
Provider Name (Legal Business Name): AVANI PATEL PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2009
Last Update Date: 11/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 W COLORADO BLVD 2ND FLOOR
DALLAS TX
75208-2382
US

IV. Provider business mailing address

122 W COLORADO BLVD 2ND FLOOR
DALLAS TX
75208-2382
US

V. Phone/Fax

Practice location:
  • Phone: 214-947-6742
  • Fax:
Mailing address:
  • Phone: 214-947-6742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number45176
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: