Provider Demographics
NPI:1437739273
Name:CHANGELA, RAHUL ANIL (PHARMD)
Entity Type:Individual
Prefix:
First Name:RAHUL
Middle Name:ANIL
Last Name:CHANGELA
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 1:4211 GRAND POINTE WAY
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31525-3519
Mailing Address - Country:US
Mailing Address - Phone:678-488-3166
Mailing Address - Fax:
Practice Address - Street 1:1605 FREDERICA ROAD
Practice Address - Street 2:
Practice Address - City:SAINT SIMONS ISLAND
Practice Address - State:GA
Practice Address - Zip Code:31522-5443
Practice Address - Country:US
Practice Address - Phone:912-638-7732
Practice Address - Fax:912-638-2329
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-14
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS64556183500000X
GARPH032321183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist