Provider Demographics
NPI:1144652462
Name:BHAKTA, HIREN VASANT (PHARMD)
Entity type:Individual
Prefix:
First Name:HIREN
Middle Name:VASANT
Last Name:BHAKTA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 DIAMOND COVE PL
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-7487
Mailing Address - Country:US
Mailing Address - Phone:915-471-3578
Mailing Address - Fax:
Practice Address - Street 1:11700 PRESTON RD
Practice Address - Street 2:STE 703
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-6112
Practice Address - Country:US
Practice Address - Phone:214-750-4502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-09
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX53665183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist