Provider Demographics
NPI:1578163655
Name:PATEL, SONAL B
Entity Type:Individual
Prefix:
First Name:SONAL
Middle Name:B
Last Name:PATEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 WALKER ST W
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31533-3445
Mailing Address - Country:US
Mailing Address - Phone:912-592-3573
Mailing Address - Fax:912-384-5528
Practice Address - Street 1:1450 BOWENS MILL RD SE
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-1500
Practice Address - Country:US
Practice Address - Phone:912-384-5492
Practice Address - Fax:912-384-5528
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH020798183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist