MEDICARE: DR. BIANCA M PATEL PHARMD

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	PST.022277	LA
2	183500000X	Pharmacist	61675	TX

General Provider Information

NPI Number	:	1124534573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BIANCA M PATEL PHARMD

Provider Business Mailing Address
First Line	:	641 BECKY LN
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70605-6676
Country	:	US
Telephone Number	:	732-277-6190
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 N 16TH ST
Second Line	:
City	:	ORANGE
State	:	TX
Zip	:	77630-3616
Country	:	US
Telephone Number	:	409-886-1362
Fax Number	:

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

Provider Enumeration Date	:	12/21/2017
Last Update Date	:	12/21/2017

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Directions to “ DR. BIANCA M PATEL PHARMD” Practice Location

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