Provider Demographics
NPI:1790816312
Name:PATEL, TEJAL A (PHARM D MBA)
Entity type:Individual
Prefix:DR
First Name:TEJAL
Middle Name:A
Last Name:PATEL
Suffix:
Gender:M
Credentials:PHARM D MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3875 MUNDY MILL RD
Mailing Address - Street 2:
Mailing Address - City:OAKWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30566-3415
Mailing Address - Country:US
Mailing Address - Phone:770-535-3702
Mailing Address - Fax:
Practice Address - Street 1:3875 MUNDY MILL RD
Practice Address - Street 2:
Practice Address - City:OAKWOOD
Practice Address - State:GA
Practice Address - Zip Code:30566-3415
Practice Address - Country:US
Practice Address - Phone:770-535-3702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH021705183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist