Provider Demographics
NPI:1477922094
Name:PATEL, GHANSHYAM
Entity Type:Individual
Prefix:
First Name:GHANSHYAM
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14215 US HIGHWAY 64 W
Mailing Address - Street 2:
Mailing Address - City:SILER CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27344-6451
Mailing Address - Country:US
Mailing Address - Phone:919-663-6001
Mailing Address - Fax:919-663-6017
Practice Address - Street 1:14215 US HIGHWAY 64 W
Practice Address - Street 2:
Practice Address - City:SILER CITY
Practice Address - State:NC
Practice Address - Zip Code:27344-6451
Practice Address - Country:US
Practice Address - Phone:919-663-6001
Practice Address - Fax:919-663-6017
Is Sole Proprietor?:No
Enumeration Date:2015-09-24
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist