Provider Demographics
NPI:1174126023
Name:PATEL, NIKUNJBHAI
Entity type:Individual
Prefix:
First Name:NIKUNJBHAI
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3785 SIXES RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-7809
Mailing Address - Country:US
Mailing Address - Phone:770-720-3466
Mailing Address - Fax:770-720-3397
Practice Address - Street 1:3785 SIXES RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-7809
Practice Address - Country:US
Practice Address - Phone:770-720-3466
Practice Address - Fax:770-720-3397
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA028195183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist