MEDICARE: HETAL PATEL DR

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	PS61297	FL

General Provider Information

NPI Number	:	1205418027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HETAL PATEL DR

Provider Business Mailing Address
First Line	:	3349 POSEIDON WAY
Second Line	:
City	:	INDIALANTIC
State	:	FL
Zip	:	32903-1839
Country	:	US
Telephone Number	:	805-294-2207
Fax Number	:	321-459-2479

Provider Business Practice Location Address
First Line	:	35 N COURTENAY PKWY
Second Line	:
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32953-3476
Country	:	US
Telephone Number	:	321-454-0911
Fax Number	:	321-459-2479

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

Provider Enumeration Date	:	04/21/2021
Last Update Date	:	04/21/2021

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Directions to “ HETAL PATEL DR” Practice Location

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