Healthcare Provider Details

I. General information

NPI: 1871199919
Provider Name (Legal Business Name): NIRALI GHANSHYAM PATEL PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2020
Last Update Date: 12/04/2020
Certification Date: 12/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5219 HIGHWAY 51 N
SENATOBIA MS
38668-1719
US

IV. Provider business mailing address

2116 HEMMINGWAY DR
NESBIT MS
38651-9405
US

V. Phone/Fax

Practice location:
  • Phone: 662-562-8266
  • Fax:
Mailing address:
  • Phone: 603-818-1907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number27020
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14382
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3505
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: