MEDICARE: DAXESH 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	12646	OK

General Provider Information

NPI Number	:	1679074033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAXESH PATEL

Provider Business Mailing Address
First Line	:	715 NW 50TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73118-6207
Country	:	US
Telephone Number	:	405-843-1501
Fax Number	:	405-843-1332

Provider Business Practice Location Address
First Line	:	715 NW 50TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73118-6207
Country	:	US
Telephone Number	:	405-843-1501
Fax Number	:	405-843-1332

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

Provider Enumeration Date	:	02/21/2018
Last Update Date	:	02/21/2018

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Directions to “ DAXESH PATEL ” Practice Location

Language	Start Address	Practice Location

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