Provider Demographics
NPI:1144791773
Name:BHATT, KRUNAL
Entity type:Individual
Prefix:
First Name:KRUNAL
Middle Name:
Last Name:BHATT
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 1:6093 SPRING RIDGE PKWY
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-5898
Mailing Address - Country:US
Mailing Address - Phone:301-631-8160
Mailing Address - Fax:301-631-8171
Practice Address - Street 1:6093 SPRING RIDGE PKWY
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-5898
Practice Address - Country:US
Practice Address - Phone:301-631-8160
Practice Address - Fax:301-631-8171
Is Sole Proprietor?:No
Enumeration Date:2018-12-07
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD19834183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist