MEDICARE: TRISHA PATEL

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	69281	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	69281	OTHER	TX	TEXAS STATE BOARD OF PHARMACY

General Provider Information

NPI Number	:	1356010995
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRISHA PATEL

Provider Business Mailing Address
First Line	:	PO BOX 368
Second Line	:
City	:	SABINE PASS
State	:	TX
Zip	:	77655-0368
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 N 16TH ST
Second Line	:
City	:	ORANGE
State	:	TX
Zip	:	77630-3616
Country	:	US
Telephone Number	:	409-886-1362
Fax Number	:

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

Provider Enumeration Date	:	09/08/2021
Last Update Date	:	10/07/2021

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Directions to “ TRISHA PATEL ” Practice Location

Language	Start Address	Practice Location

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