Provider Demographics
NPI:1528668175
Name:PATEL, VISHWA
Entity type:Individual
Prefix:
First Name:VISHWA
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3604 BELLHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31605-1210
Mailing Address - Country:US
Mailing Address - Phone:863-558-2522
Mailing Address - Fax:229-244-7677
Practice Address - Street 1:3604 BELLHAVEN DR
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31605-1210
Practice Address - Country:US
Practice Address - Phone:863-558-2522
Practice Address - Fax:229-244-7677
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-31
Last Update Date:2020-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH025836183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist