Provider Demographics
NPI:1194557157
Name:PATEL, NISHA RAKESHBHAI (RPH)
Entity type:Individual
Prefix:
First Name:NISHA
Middle Name:RAKESHBHAI
Last Name:PATEL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 FOX CROFT RD NW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-7609
Mailing Address - Country:US
Mailing Address - Phone:770-731-3624
Mailing Address - Fax:
Practice Address - Street 1:435 TURNER MCCALL BLVD NE
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-2735
Practice Address - Country:US
Practice Address - Phone:706-291-3385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH035093183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist