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General NPI Number Information
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NPI Number | 1912503608
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Entity Type | Individual
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Provider Name | MITESH PATEL PHARMD.
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Gender | Male
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Dates
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Enumeration Date | 12/08/2020
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Last Update Date | 12/08/2020
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Provider Practice Location Address
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Address Line | 1901 RICHMOND RD
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City | TEXARKANA
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State | TX
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Zip | 75503-2424
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Country | US
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Telephone | 903-255-0316
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Fax |
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Provider Business Mailing Address
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Address Line | 15 ONEIDA CIR
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City | MAUMELLE
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State | AR
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Zip | 72113-5877
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Country | US
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Telephone | 501-960-5494
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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 | PD14619
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 63938
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License Number State | TX
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