MEDICARE: MR. PRASHANT K PATEL MS, MBA, R PH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PS36305	FL

General Provider Information

NPI Number	:	1053659425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PRASHANT K PATEL MS, MBA, R PH

Provider Business Mailing Address
First Line	:	200 MOODY BLVD
Second Line	:
City	:	FLAGLER BEACH
State	:	FL
Zip	:	32136-3372
Country	:	US
Telephone Number	:	904-728-7283
Fax Number	:	386-426-6600

Provider Business Practice Location Address
First Line	:	200 MOODY BLVD
Second Line	:
City	:	FLAGLER BEACH
State	:	FL
Zip	:	32136-6127
Country	:	US
Telephone Number	:	904-728-7283
Fax Number	:	386-426-6600

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2013
Last Update Date	:	09/20/2018

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