Healthcare Provider Details

I. General information

NPI: 1568061455
Provider Name (Legal Business Name): RACHNA DHIRUBHAI PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2020
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4155 HIGHWAY 29 NW
LILBURN GA
30047-1500
US

IV. Provider business mailing address

4155 HIGHWAY 29 NW
LILBURN GA
30047-2878
US

V. Phone/Fax

Practice location:
  • Phone: 770-717-3044
  • Fax:
Mailing address:
  • Phone: 770-717-3044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRPH032318
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: