Provider Demographics
NPI:1003239526
Name:PATEL, KAUSHIK (RPH)
Entity Type:Individual
Prefix:
First Name:KAUSHIK
Middle Name:
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 1:1069 WOODTRACE LN
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30011-4727
Mailing Address - Country:US
Mailing Address - Phone:678-772-1029
Mailing Address - Fax:
Practice Address - Street 1:1069 WOODTRACE LN
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:GA
Practice Address - Zip Code:30011-4727
Practice Address - Country:US
Practice Address - Phone:678-772-1029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-04
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH024473183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist