Provider Demographics
NPI:1598404410
Name:PATEL, KEJAL V (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:KEJAL
Middle Name:V
Last Name:PATEL
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 OLD MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31605-7937
Mailing Address - Country:US
Mailing Address - Phone:229-834-8100
Mailing Address - Fax:
Practice Address - Street 1:1111 OLD MEADOW RD
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31605-7937
Practice Address - Country:US
Practice Address - Phone:229-834-8100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH0286701835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARPH028670OtherRPH LICENSE