MEDICARE: TINA PATEL RPH

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	24817	MD

General Provider Information

NPI Number	:	1558919555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TINA PATEL RPH

Provider Business Mailing Address
First Line	:	424 GEORGE CLAUSS BLVD.
Second Line	:	SAM'S CLUB PHARMACY 4771
City	:	SEVERN
State	:	MD
Zip	:	21144-2046
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	424 GEORGE CLAUSS BLVD
Second Line	:
City	:	SEVERN
State	:	MD
Zip	:	21144-1300
Country	:	US
Telephone Number	:	410-969-5491
Fax Number	:

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

Provider Enumeration Date	:	09/03/2019
Last Update Date	:	11/09/2020

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