Provider Demographics
NPI:1407408727
Name:PATEL, SAUMIL R (PHARMD)
Entity Type:Individual
Prefix:
First Name:SAUMIL
Middle Name:R
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 1:1215 BAYTREE DR
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31793-8056
Mailing Address - Country:US
Mailing Address - Phone:229-326-6997
Mailing Address - Fax:
Practice Address - Street 1:1114 GA HIGHWAY 96
Practice Address - Street 2:
Practice Address - City:KATHLEEN
Practice Address - State:GA
Practice Address - Zip Code:31047-4101
Practice Address - Country:US
Practice Address - Phone:478-987-6788
Practice Address - Fax:478-987-6920
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-16
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH031409183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist