=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255450839
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHETAN PATEL PHARM. D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2007
-----------------------------------------------------
Last Update Date | 12/19/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7171 N DALE MABRY HWY
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33614-2665
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-558-8858
-----------------------------------------------------
Fax | 813-558-8071
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15639 INDIAN QUEEN DR
-----------------------------------------------------
City | ODESSA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33556-3012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-300-3369
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PS18870
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------