MEDICARE: RAJDEEP 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	PS38192	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PS38192	OTHER	FL	STATE LICENSE

General Provider Information

NPI Number	:	1942576202
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAJDEEP PATEL

Provider Business Mailing Address
First Line	:	6229 14TH ST W
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34207-4611
Country	:	US
Telephone Number	:	941-753-6075
Fax Number	:	941-753-1417

Provider Business Practice Location Address
First Line	:	6229 14TH ST W
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34207-4611
Country	:	US
Telephone Number	:	941-753-6075
Fax Number	:	941-753-1417

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

Provider Enumeration Date	:	03/30/2012
Last Update Date	:	03/30/2012

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Directions to “ RAJDEEP PATEL ” Practice Location

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