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General NPI Number Information
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NPI Number | 1710394960
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Entity Type | Individual
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Provider Name | EKTAA PATEL
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Gender | Female
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Dates
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Enumeration Date | 07/21/2014
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Last Update Date | 07/21/2014
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Provider Practice Location Address
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Address Line | 2340 HIGHWAY 77
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City | PANAMA CITY
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State | FL
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Zip | 32405-4404
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Country | US
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Telephone | 850-319-7923
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Fax |
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Provider Business Mailing Address
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Address Line | 5003 W HIGHWAY 98
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City | PANAMA CITY
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State | FL
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Zip | 32401-1036
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Country | US
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Telephone | 850-769-2101
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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 | PS52050
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License Number State | FL
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