Provider Demographics
NPI:1518517564
Name:PATEL, JIGNESH ATMARAM (RPH)
Entity type:Individual
Prefix:
First Name:JIGNESH
Middle Name:ATMARAM
Last Name:PATEL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7408 SIKA DEER WAY
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33966-5712
Mailing Address - Country:US
Mailing Address - Phone:201-675-0189
Mailing Address - Fax:
Practice Address - Street 1:2020 NE PINE ISLAND RD
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33909-1766
Practice Address - Country:US
Practice Address - Phone:239-800-6067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-11
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPU8352183500000X
FLPS36240183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist