Healthcare Provider Details

I. General information

NPI: 1033847447
Provider Name (Legal Business Name): ANISH JAYESH PATEL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2022
Last Update Date: 08/12/2022
Certification Date: 08/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 HIGHWAY 45 S
WEST POINT MS
39773-9353
US

IV. Provider business mailing address

1313 HIGHWAY 45 S
WEST POINT MS
39773-9353
US

V. Phone/Fax

Practice location:
  • Phone: 662-494-7267
  • Fax:
Mailing address:
  • Phone: 662-494-7267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberE-100830
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: