MEDICARE: PUSHPA SHAILESH 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	PS36350	FL

General Provider Information

NPI Number	:	1629163357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PUSHPA SHAILESH PATEL PHARM D.

Provider Business Mailing Address
First Line	:	5614 S. MANHATTAN AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33616-1043
Country	:	US
Telephone Number	:	813-839-4800
Fax Number	:	813-839-4883

Provider Business Practice Location Address
First Line	:	5614 S. MANHATTAN AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33616-1043
Country	:	US
Telephone Number	:	813-839-4800
Fax Number	:	813-839-4883

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

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	07/08/2007

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