Provider Demographics
NPI:1851874119
Name:PATEL, NIKKIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:NIKKIE
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 1:507 PINEY GROVE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-3405
Mailing Address - Country:US
Mailing Address - Phone:803-875-7140
Mailing Address - Fax:803-875-7131
Practice Address - Street 1:507 PINEY GROVE RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-3405
Practice Address - Country:US
Practice Address - Phone:803-875-7140
Practice Address - Fax:803-875-7131
Is Sole Proprietor?:No
Enumeration Date:2018-09-12
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC37749183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist