Provider Demographics
NPI:1962093286
Name:PATEL, POOJA P
Entity type:Individual
Prefix:
First Name:POOJA
Middle Name:P
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 1:1190 INDIAN TRAIL RD
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-4594
Mailing Address - Country:US
Mailing Address - Phone:770-638-8958
Mailing Address - Fax:
Practice Address - Street 1:1190 INDIAN TRAIL RD
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-4594
Practice Address - Country:US
Practice Address - Phone:770-638-8958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-29
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH032495183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist