Provider Demographics
NPI:1114241551
Name:PATEL, KEYURKUMAR (RPH)
Entity Type:Individual
Prefix:
First Name:KEYURKUMAR
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 1:511 WOODLORE LN NW
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-3588
Mailing Address - Country:US
Mailing Address - Phone:404-606-2440
Mailing Address - Fax:
Practice Address - Street 1:4075 CHEROKEE ST NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-1278
Practice Address - Country:US
Practice Address - Phone:770-528-5651
Practice Address - Fax:770-528-5949
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-14
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA025294183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist