Provider Demographics
NPI:1215406673
Name:PATEL, ANKITKUMAR (PHARMD)
Entity type:Individual
Prefix:
First Name:ANKITKUMAR
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 CIRCLE WAY ST STE 7F
Mailing Address - Street 2:
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-5222
Mailing Address - Country:US
Mailing Address - Phone:979-341-9811
Mailing Address - Fax:979-341-9822
Practice Address - Street 1:120 CIRCLE WAY ST STE 7F
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-5222
Practice Address - Country:US
Practice Address - Phone:979-341-9811
Practice Address - Fax:979-341-9822
Is Sole Proprietor?:No
Enumeration Date:2018-11-15
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX53511183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist