Provider Demographics
NPI:1114269537
Name:PATEL, JIGNESH GAUTAMBHAI (R PH)
Entity Type:Individual
Prefix:
First Name:JIGNESH
Middle Name:GAUTAMBHAI
Last Name:PATEL
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2811 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-2758
Mailing Address - Country:US
Mailing Address - Phone:864-225-2321
Mailing Address - Fax:
Practice Address - Street 1:2811 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-2758
Practice Address - Country:US
Practice Address - Phone:864-225-2321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-24
Last Update Date:2013-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13987183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist