Provider Demographics
NPI:1396408480
Name:PATEL, VIVEK BHAVAS (PHARMD)
Entity Type:Individual
Prefix:
First Name:VIVEK
Middle Name:BHAVAS
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 1:44 BRAVES AVE APT 2303
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-3371
Mailing Address - Country:US
Mailing Address - Phone:864-337-9880
Mailing Address - Fax:
Practice Address - Street 1:44 BRAVES AVE APT 2303
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-3371
Practice Address - Country:US
Practice Address - Phone:864-337-9880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-16
Last Update Date:2021-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH033360183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist