Provider Demographics
NPI:1528875549
Name:BULSARA, NITA KETAN (RPH)
Entity type:Individual
Prefix:
First Name:NITA
Middle Name:KETAN
Last Name:BULSARA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 ACORN DR
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:CT
Mailing Address - Zip Code:06524-3383
Mailing Address - Country:US
Mailing Address - Phone:919-672-2559
Mailing Address - Fax:
Practice Address - Street 1:245 AMITY RD STE 111
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:CT
Practice Address - Zip Code:06525-2288
Practice Address - Country:US
Practice Address - Phone:203-298-4338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-12
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0011870183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist