Provider Demographics
NPI:1285122903
Name:PATEL, KEVIN SURESH (PHARMD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:SURESH
Last Name:PATEL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 ACORN OAKS CIR APT 325
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37405-2088
Mailing Address - Country:US
Mailing Address - Phone:931-409-3695
Mailing Address - Fax:
Practice Address - Street 1:7636 MIDDLE VALLEY RD
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-2237
Practice Address - Country:US
Practice Address - Phone:423-242-0623
Practice Address - Fax:423-242-0624
Is Sole Proprietor?:No
Enumeration Date:2018-04-27
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN39255183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist