Provider Demographics
NPI:1144937269
Name:PATEL, DIVYA H (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DIVYA
Middle Name:H
Last Name:PATEL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 ASH BREEZE CV
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32095-0044
Mailing Address - Country:US
Mailing Address - Phone:815-529-2733
Mailing Address - Fax:
Practice Address - Street 1:175 STATE ROAD 312 W
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-4201
Practice Address - Country:US
Practice Address - Phone:815-529-2733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-28
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS63413183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist