Provider Demographics
NPI:1366088684
Name:PATEL, BHAVIK S (RPH)
Entity type:Individual
Prefix:
First Name:BHAVIK
Middle Name:S
Last Name:PATEL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:BHAVIKKUMAR
Other - Middle Name:S
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:355 CYPRESS GDN BLVD
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-4452
Mailing Address - Country:US
Mailing Address - Phone:863-299-5131
Mailing Address - Fax:863-299-0547
Practice Address - Street 1:355 CYPRESS GDN BLVD
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-4452
Practice Address - Country:US
Practice Address - Phone:863-299-5131
Practice Address - Fax:863-299-0547
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-21
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS36273183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty