Provider Demographics
NPI:1992454490
Name:PATEL, HETAL S (PHARMD)
Entity type:Individual
Prefix:
First Name:HETAL
Middle Name:S
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 1:6176 SECOND ST N
Mailing Address - Street 2:
Mailing Address - City:FOLKSTON
Mailing Address - State:GA
Mailing Address - Zip Code:31537-9359
Mailing Address - Country:US
Mailing Address - Phone:919-360-1043
Mailing Address - Fax:
Practice Address - Street 1:515 S. CITY BLVD
Practice Address - Street 2:STE D & E
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501
Practice Address - Country:US
Practice Address - Phone:919-360-1043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-22
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS43338183500000X
NC18897183500000X
GARPH024062183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist