Provider Demographics
NPI:1508455973
Name:PATEL, KAUSHAL (RPH)
Entity Type:Individual
Prefix:
First Name:KAUSHAL
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 W BROUGHTON ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31401-3218
Mailing Address - Country:US
Mailing Address - Phone:912-999-6101
Mailing Address - Fax:912-777-5953
Practice Address - Street 1:418 W BROUGHTON ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31401-3218
Practice Address - Country:US
Practice Address - Phone:912-999-6101
Practice Address - Fax:912-777-5953
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH028252183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty