Provider Demographics
NPI:1144324385
Name:PATEL, JIMMY BHOGILAL
Entity type:Individual
Prefix:MRS
First Name:JIMMY
Middle Name:BHOGILAL
Last Name:PATEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8888 FALCON POINTE LOOP
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-1473
Mailing Address - Country:US
Mailing Address - Phone:239-267-5673
Mailing Address - Fax:
Practice Address - Street 1:1145 HOMESTEAD RD N
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33936-6039
Practice Address - Country:US
Practice Address - Phone:239-368-2100
Practice Address - Fax:239-368-2289
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS40727183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist