Active NPI
Mallika Kantilal Patel, PHARM.D.
- Ambulatory Care Pharmacist
- Hinesville, GA
National Provider Identifier
1194716977
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ambulatory Care Pharmacist
- License
- 17103
- Practice address
- 500 E Oglethorpe Hwy
Hinesville, GA 31313-2804 - Phone
- (912) 408-2921
- NPI assigned
- Nov 2, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ambulatory Care Pharmacist | 1835P2201X | 17103 | LA | Primary |
Addresses
Primary practice location
500 E Oglethorpe Hwy
Hinesville, GA 31313-2804
Mailing address
1061 Harmon Ave
Fort Stewart, GA 31314-5641
Phone (912) 435-6618
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151102001055 | GA | Order and Referring Only - Other (Non-Physician) | 4981914082 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17103 | LA | MD | Ambulatory Care Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1130889600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1544745600000",
"number": "1194716977",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1061 HARMON AVE",
"city": "FORT STEWART",
"state": "GA",
"postal_code": "313145641",
"telephone_number": "912-435-6618"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 E OGLETHORPE HWY",
"city": "HINESVILLE",
"state": "GA",
"postal_code": "313132804",
"telephone_number": "912-408-2921"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PATEL",
"first_name": "MALLIKA",
"middle_name": "KANTILAL",
"name_prefix": "Mrs.",
"credential": "PHARM.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-11-02",
"last_updated": "2018-12-14",
"status": "A"
},
"taxonomies": [
{
"code": "1835P2201X",
"taxonomy_group": "",
"desc": "Pharmacist, Ambulatory Care",
"state": "LA",
"license": "17103",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hinesville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.