=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760852446
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MONA PATEL
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/06/2015
-----------------------------------------------------
Last Update Date | 06/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5000 AMBASSADOR CAFFERY PKWY STE B
-----------------------------------------------------
City | LAFAYETTE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70508-6984
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-706-4931
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 513 RUE DES ETOILES
-----------------------------------------------------
City | CARENCRO
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70520-5635
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-706-4931
-----------------------------------------------------
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 | PST.021182
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------