Healthcare Provider Details

I. General information

NPI: 1497305007
Provider Name (Legal Business Name): ANKIT PATEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2019
Last Update Date: 09/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 S HOUSTON LAKE RD STE 300
WARNER ROBINS GA
31088-9056
US

IV. Provider business mailing address

150 S HOUSTON LAKE RD STE 300
WARNER ROBINS GA
31088-9056
US

V. Phone/Fax

Practice location:
  • Phone: 478-333-6767
  • Fax: 478-333-6228
Mailing address:
  • Phone: 478-333-6767
  • Fax: 478-333-6228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHRE010401
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: