MEDICARE: DR. DIMPLE P PATEL PHARM.D

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	PS30173	FL
2	183500000X	Pharmacist	28RI02151300	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1075159	OTHER		NCPDP

General Provider Information

NPI Number	:	1144344086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIMPLE P PATEL PHARM.D

Provider Business Mailing Address
First Line	:	1714 THOROUGHBRED DR
Second Line	:
City	:	GOTHA
State	:	FL
Zip	:	34734-5129
Country	:	US
Telephone Number	:	321-947-2800
Fax Number	:

Provider Business Practice Location Address
First Line	:	1531 E SILVER STAR RD
Second Line	:
City	:	OCOEE
State	:	FL
Zip	:	34761-2553
Country	:	US
Telephone Number	:	407-299-6960
Fax Number	:	407-299-7552

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

Provider Enumeration Date	:	03/17/2007
Last Update Date	:	07/08/2007

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