Healthcare Provider Details

I. General information

NPI: 1760096341
Provider Name (Legal Business Name): HITEN PATEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2020
Last Update Date: 09/01/2020
Certification Date: 09/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24917 FM 1314 RD
PORTER TX
77365-4982
US

IV. Provider business mailing address

24917 FM 1314 RD
PORTER TX
77365-4982
US

V. Phone/Fax

Practice location:
  • Phone: 281-354-1792
  • Fax: 281-354-8239
Mailing address:
  • Phone: 281-354-1792
  • Fax: 281-354-8239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number61419
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: