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General NPI Number Information
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NPI Number | 1144937269
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Entity Type | Individual
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Provider Name | DIVYA H PATEL PHARMD
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Gender | Female
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Dates
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Enumeration Date | 10/28/2022
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Last Update Date | 10/28/2022
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Provider Practice Location Address
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Address Line | 175 STATE ROAD 312 W
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-4201
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Country | US
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Telephone | 815-529-2733
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Fax |
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Provider Business Mailing Address
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Address Line | 249 ASH BREEZE CV
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City | ST AUGUSTINE
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State | FL
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Zip | 32095-0044
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Country | US
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Telephone | 815-529-2733
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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 | PS63413
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License Number State | FL
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