Provider Demographics
NPI:1699504639
Name:PATEL, SHAKTI VINOD (PHARMD)
Entity type:Individual
Prefix:
First Name:SHAKTI
Middle Name:VINOD
Last Name:PATEL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5421 NEW JESUP HWY
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31523-1119
Mailing Address - Country:US
Mailing Address - Phone:912-264-1321
Mailing Address - Fax:
Practice Address - Street 1:5421 NEW JESUP HWY
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31523-1119
Practice Address - Country:US
Practice Address - Phone:912-264-1321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH034616183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist