Provider Demographics
NPI:1902323348
Name:BHAKTA, HARIVADANKUMAR
Entity Type:Individual
Prefix:
First Name:HARIVADANKUMAR
Middle Name:
Last Name:BHAKTA
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 1:620 KRISTINE WAY
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32163-0286
Mailing Address - Country:US
Mailing Address - Phone:352-330-6722
Mailing Address - Fax:352-330-6723
Practice Address - Street 1:620 KRISTINE WAY
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32163-0286
Practice Address - Country:US
Practice Address - Phone:352-330-6722
Practice Address - Fax:352-330-6723
Is Sole Proprietor?:No
Enumeration Date:2017-08-26
Last Update Date:2017-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS50737183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist