MEDICARE: SHIVAM PATEL PHARMD

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	PD13710	AR

General Provider Information

NPI Number	:	1932709185
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHIVAM PATEL PHARMD

Provider Business Mailing Address
First Line	:	3704 LAVORTON PL
Second Line	:
City	:	FLOWER MOUND
State	:	TX
Zip	:	75022-6707
Country	:	US
Telephone Number	:	682-521-2317
Fax Number	:

Provider Business Practice Location Address
First Line	:	4019 CENTRAL AVE
Second Line	:
City	:	HOT SPRINGS
State	:	AR
Zip	:	71913-7208
Country	:	US
Telephone Number	:	501-623-7689
Fax Number	:

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

Provider Enumeration Date	:	10/27/2020
Last Update Date	:	10/27/2020

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Directions to “ SHIVAM PATEL PHARMD” Practice Location

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