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General NPI Number Information
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NPI Number | 1649876236
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Entity Type | Individual
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Provider Name | KISHAN PATEL PHARMD
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Gender | Male
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Dates
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Enumeration Date | 12/08/2020
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Last Update Date | 12/08/2020
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Provider Practice Location Address
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Address Line | 2738 N DECATUR RD
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City | DECATUR
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State | GA
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Zip | 30033-5910
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Country | US
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Telephone | 404-508-8058
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Fax |
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Provider Business Mailing Address
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Address Line | 305 TAMBEC TRCE NW
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City | LILBURN
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State | GA
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Zip | 30047-2864
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Country | US
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Telephone | 404-918-7189
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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