Provider Demographics
NPI:1538623533
Name:KUMAR, BHAVIKA UMESH
Entity type:Individual
Prefix:
First Name:BHAVIKA
Middle Name:UMESH
Last Name:KUMAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1681 US 29 BUSINESS
Mailing Address - Street 2:
Mailing Address - City:REIDSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27320-8219
Mailing Address - Country:US
Mailing Address - Phone:336-432-8406
Mailing Address - Fax:
Practice Address - Street 1:3069 RICHLANDS HWY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-2976
Practice Address - Country:US
Practice Address - Phone:910-219-0490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-24
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC28421183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist