Provider Demographics
NPI:1811597719
Name:PATEL, CHANDANI (PHARMD)
Entity Type:Individual
Prefix:
First Name:CHANDANI
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 PEMBROKE PT
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31028-8043
Mailing Address - Country:US
Mailing Address - Phone:636-290-5223
Mailing Address - Fax:
Practice Address - Street 1:1401 GRAY HWY
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31211-1905
Practice Address - Country:US
Practice Address - Phone:478-755-1097
Practice Address - Fax:478-755-8218
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH030106183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist