Provider Demographics
NPI:1942583059
Name:PATEL, AMITKUMAR KANTILAL
Entity Type:Individual
Prefix:
First Name:AMITKUMAR
Middle Name:KANTILAL
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4432 LIPPENCOTT LN
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-3639
Mailing Address - Country:US
Mailing Address - Phone:248-925-0349
Mailing Address - Fax:
Practice Address - Street 1:4391 ACWORTH DALLAS RD NW
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-4334
Practice Address - Country:US
Practice Address - Phone:770-370-2235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-25
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302039247183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist