Provider Demographics
NPI:1073392122
Name:PATEL, LEHA GAURANGBHAI
Entity Type:Individual
Prefix:
First Name:LEHA
Middle Name:GAURANGBHAI
Last Name:PATEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LEHA
Other - Middle Name:SATISHBHAI
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2815 N ASHLEY ST
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1806
Mailing Address - Country:US
Mailing Address - Phone:229-253-9069
Mailing Address - Fax:
Practice Address - Street 1:2815 N ASHLEY ST
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1806
Practice Address - Country:US
Practice Address - Phone:229-253-9069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH034575183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist