Provider Demographics
NPI:1164875027
Name:PATEL, JAY KISHOR (PHARMD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:KISHOR
Last Name:PATEL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4328 CUMMINGS HWY
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37419-2106
Mailing Address - Country:US
Mailing Address - Phone:423-596-5237
Mailing Address - Fax:
Practice Address - Street 1:490 GREENWAY VIEW DR
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37411-5689
Practice Address - Country:US
Practice Address - Phone:423-892-2554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-15
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN40468183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist