Provider Demographics
NPI:1346735644
Name:PATEL, MONALI (PHARM D)
Entity Type:Individual
Prefix:
First Name:MONALI
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 GWINNETT DR STE 111
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-8401
Mailing Address - Country:US
Mailing Address - Phone:678-993-0687
Mailing Address - Fax:
Practice Address - Street 1:175 GWINNETT DR STE 111
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-8401
Practice Address - Country:US
Practice Address - Phone:678-993-0687
Practice Address - Fax:678-993-0687
Is Sole Proprietor?:No
Enumeration Date:2018-06-28
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH025480183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist