Provider Demographics
NPI:1407440183
Name:PATEL, NITA R (DOCTORATE PHARMACY)
Entity Type:Individual
Prefix:
First Name:NITA
Middle Name:R
Last Name:PATEL
Suffix:
Gender:F
Credentials:DOCTORATE PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1247 W WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-3958
Mailing Address - Country:US
Mailing Address - Phone:240-723-2375
Mailing Address - Fax:
Practice Address - Street 1:1247 W WALNUT AVE
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-3958
Practice Address - Country:US
Practice Address - Phone:706-428-9003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-23
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH023013183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist