Provider Demographics
NPI:1700480217
Name:PATEL, KEYURKUMAR KANTILAL
Entity type:Individual
Prefix:
First Name:KEYURKUMAR
Middle Name:KANTILAL
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5011 STATE ST STE A
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37407-3535
Mailing Address - Country:US
Mailing Address - Phone:423-867-7303
Mailing Address - Fax:423-867-7327
Practice Address - Street 1:5011 STATE ST STE A
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37407-3535
Practice Address - Country:US
Practice Address - Phone:423-867-7303
Practice Address - Fax:423-867-7327
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN22854183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist