Provider Demographics
NPI:1265169148
Name:PATEL, DIVYESH M
Entity type:Individual
Prefix:
First Name:DIVYESH
Middle Name:M
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 1:508 E TRI COUNTY BLVD
Mailing Address - Street 2:
Mailing Address - City:OLIVER SPRINGS
Mailing Address - State:TN
Mailing Address - Zip Code:37840-2018
Mailing Address - Country:US
Mailing Address - Phone:865-435-1187
Mailing Address - Fax:
Practice Address - Street 1:508 E TRI COUNTY BLVD
Practice Address - Street 2:
Practice Address - City:OLIVER SPRINGS
Practice Address - State:TN
Practice Address - Zip Code:37840-2018
Practice Address - Country:US
Practice Address - Phone:865-435-1187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-02
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN46287183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist