Provider Demographics
NPI:1215350574
Name:PATEL, SAMIR M (PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:SAMIR
Middle Name:M
Last Name:PATEL
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 WHITETHORN LN
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-5676
Mailing Address - Country:US
Mailing Address - Phone:973-462-4429
Mailing Address - Fax:864-671-0301
Practice Address - Street 1:3405 WHITE HORSE RD STE F
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29611-5947
Practice Address - Country:US
Practice Address - Phone:864-671-0300
Practice Address - Fax:864-671-0301
Is Sole Proprietor?:No
Enumeration Date:2014-01-22
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCPH35384183500000X
AZS017213183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC717095Medicaid