MEDICARE: CHETAN 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	PS18870	FL

General Provider Information

NPI Number	:	1255450839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHETAN PATEL PHARM. D.

Provider Business Mailing Address
First Line	:	15639 INDIAN QUEEN DR
Second Line	:
City	:	ODESSA
State	:	FL
Zip	:	33556-3012
Country	:	US
Telephone Number	:	813-300-3369
Fax Number	:

Provider Business Practice Location Address
First Line	:	7171 N DALE MABRY HWY
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-2665
Country	:	US
Telephone Number	:	813-558-8858
Fax Number	:	813-558-8071

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

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	12/19/2015

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