Provider Demographics
NPI:1235252644
Name:PATEL, NIMISHA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NIMISHA
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6074 BROOKMERE LN
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-2782
Mailing Address - Country:US
Mailing Address - Phone:678-945-6463
Mailing Address - Fax:
Practice Address - Street 1:4798 JIMMY LEE SMITH PKWY
Practice Address - Street 2:
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141-2729
Practice Address - Country:US
Practice Address - Phone:678-567-5980
Practice Address - Fax:678-567-5982
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH021823183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist