Provider Demographics
NPI:1912241720
Name:PATEL, PRATYUSHA CHETAN (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:PRATYUSHA
Middle Name:CHETAN
Last Name:PATEL
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 S DAVIS ST
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31639-2441
Mailing Address - Country:US
Mailing Address - Phone:229-686-5113
Mailing Address - Fax:229-686-6598
Practice Address - Street 1:402 S DAVIS ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:GA
Practice Address - Zip Code:31639-2441
Practice Address - Country:US
Practice Address - Phone:229-686-5113
Practice Address - Fax:229-686-6598
Is Sole Proprietor?:No
Enumeration Date:2012-11-16
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17214183500000X
GARPH026976183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist