Basic Information
| Provider Information | |||||||||
| NPI: | 1093262990 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | JAY | ||||||||
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| Credential: | R.PH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 205 CROSS RD | ||||||||
| Address2: | |||||||||
| City: | ACWORTH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301021349 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3302563143 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1668 MULKEY RD | ||||||||
| Address2: | |||||||||
| City: | AUSTELL | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301061143 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709483233 | ||||||||
| FaxNumber: | 7709441537 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2016 | ||||||||
| LastUpdateDate: | 09/08/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1835X0200X | RPH028066 | GA | Y | Pharmacy Service Providers | Pharmacist | Oncology |
No ID Information.