MEDICARE: MEHAL PATEL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	028347	GA

General Provider Information

NPI Number	:	1871221432
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEHAL PATEL

Provider Business Mailing Address
First Line	:	3709 THOMPSON BRIDGE RD
Second Line	:
City	:	GAINESVILLE
State	:	GA
Zip	:	30506-5303
Country	:	US
Telephone Number	:	770-503-7454
Fax Number	:

Provider Business Practice Location Address
First Line	:	3709 THOMPSON BRIDGE RD
Second Line	:
City	:	GAINESVILLE
State	:	GA
Zip	:	30506-5303
Country	:	US
Telephone Number	:	770-503-7454
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2022
Last Update Date	:	08/11/2022

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Directions to “ MEHAL PATEL ” Practice Location

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