Healthcare Provider Details

I. General information

NPI: 1477414753
Provider Name (Legal Business Name): KRUNAL PATEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2025
Last Update Date: 11/18/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9255 FM 471
SAN ANTONIO TX
78251
US

IV. Provider business mailing address

11314 PHOEBE LACE
SAN ANTONIO TX
78253-6261
US

V. Phone/Fax

Practice location:
  • Phone: 210-680-2958
  • Fax:
Mailing address:
  • Phone: 812-781-1912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number258704
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: