Provider Demographics
NPI:1003902420
Name:PATEL, MANISH J
Entity Type:Individual
Prefix:MR
First Name:MANISH
Middle Name:J
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:MRS
Other - First Name:RIMISHA
Other - Middle Name:M
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:11330 LAKEFIELD DR
Mailing Address - Street 2:SUITE 200 BUILDING #2
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-4425
Mailing Address - Country:US
Mailing Address - Phone:404-680-2107
Mailing Address - Fax:
Practice Address - Street 1:11330 LAKEFIELD DR
Practice Address - Street 2:SUITE 200 BUILDING #2
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-4425
Practice Address - Country:US
Practice Address - Phone:404-680-2107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH020630183500000X
NJRI26021183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist