Healthcare Provider Details

I. General information

NPI: 1245865740
Provider Name (Legal Business Name): DHARMESH PATEL RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2020
Last Update Date: 03/05/2020
Certification Date: 03/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9205 LAVONIA RD
CARNESVILLE GA
30521-3203
US

IV. Provider business mailing address

5460 ENFIELD WAY
SUWANEE GA
30024-4455
US

V. Phone/Fax

Practice location:
  • Phone: 706-384-2085
  • Fax:
Mailing address:
  • Phone: 706-495-4469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHRE010393
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: