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General NPI Number Information
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NPI Number | 1134766595
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Entity Type | Individual
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Provider Name | MAMTA PRADIP PATEL PHARM.D
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Gender | Female
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Dates
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Enumeration Date | 12/04/2019
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 9305 RIVER OTTER DR
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City | FORT MYERS
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State | FL
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Zip | 33912-8925
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Country | US
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Telephone | 423-774-0142
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Fax |
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Provider Business Mailing Address
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Address Line | 2000 KINGS HWY
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City | PORT CHARLOTTE
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State | FL
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Zip | 33980-4214
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Country | US
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Telephone | 941-629-1512
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PS47419
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License Number State | FL
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