Provider Demographics
NPI:1407574882
Name:GAYATRIMATA LLC
Entity Type:Organization
Organization Name:GAYATRIMATA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY OWNER
Authorized Official - Prefix:
Authorized Official - First Name:METESH
Authorized Official - Middle Name:JAYANTILAL
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-650-3605
Mailing Address - Street 1:2670 KENSINGTON PARK TRL NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-2298
Mailing Address - Country:US
Mailing Address - Phone:423-650-3605
Mailing Address - Fax:
Practice Address - Street 1:2296 DALTON PIKE SE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-7752
Practice Address - Country:US
Practice Address - Phone:423-650-3605
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy