Healthcare Provider Details

I. General information

NPI: 1760767362
Provider Name (Legal Business Name): NILESH PATEL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2011
Last Update Date: 10/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 RUSSELL PKWY
WARNER ROBINS GA
31088-6165
US

IV. Provider business mailing address

102 RUSSELL PKWY
WARNER ROBINS GA
31088-6165
US

V. Phone/Fax

Practice location:
  • Phone: 478-542-2064
  • Fax:
Mailing address:
  • Phone: 478-542-2064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH025683
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: