MEDICARE: DEVENDRA KUMAR PATCHALA

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	50052	TX
2	183500000X	Pharmacist	PD12250	AR
3	183500000X	Pharmacist	S019713	AZ
4	183500000X	Pharmacist	PST.020136	LA

General Provider Information

NPI Number	:	1508207093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEVENDRA KUMAR PATCHALA

Provider Business Mailing Address
First Line	:	2743 W 15TH ST
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75075-7525
Country	:	US
Telephone Number	:	214-919-2090
Fax Number	:	214-919-2091

Provider Business Practice Location Address
First Line	:	2743 W 15TH ST
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75075-7525
Country	:	US
Telephone Number	:	214-919-2090
Fax Number	:	214-919-2091

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

Provider Enumeration Date	:	07/11/2013
Last Update Date	:	07/11/2013

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Directions to “ DEVENDRA KUMAR PATCHALA ” Practice Location

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