MEDICARE: DR. PRASHANT 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	16025	NC

General Provider Information

NPI Number	:	1265767701
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PRASHANT PATEL PHARMD

Provider Business Mailing Address
First Line	:	5455 POTTERS ROAD
Second Line	:	WALGREENS 12350
City	:	STALLINGS
State	:	NC
Zip	:	28104
Country	:	US
Telephone Number	:	704-821-0411
Fax Number	:	704-821-0495

Provider Business Practice Location Address
First Line	:	5455 POTTERS ROAD
Second Line	:	WALGREENS 12350
City	:	STALLINGS
State	:	NC
Zip	:	28104
Country	:	US
Telephone Number	:	704-821-0411
Fax Number	:	704-821-0495

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

Provider Enumeration Date	:	10/15/2009
Last Update Date	:	03/09/2010

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