MEDICARE: JINAL S PATEL PHARMACIST

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	PS43356	FL

General Provider Information

NPI Number	:	1164769022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JINAL S PATEL PHARMACIST

Provider Business Mailing Address
First Line	:	4195 W LAKE MARY BLVD
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-2410
Country	:	US
Telephone Number	:	407-328-3062
Fax Number	:	407-328-3068

Provider Business Practice Location Address
First Line	:	4195 W LAKE MARY BLVD
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-2410
Country	:	US
Telephone Number	:	407-328-3062
Fax Number	:	407-328-3068

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

Provider Enumeration Date	:	01/12/2013
Last Update Date	:	01/12/2013

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