Provider Demographics
NPI:1548553720
Name:MAHADEO, BHARAT BHUSHAN (RPH)
Entity type:Individual
Prefix:
First Name:BHARAT
Middle Name:BHUSHAN
Last Name:MAHADEO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10311 LEFFERTS BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11419-2011
Mailing Address - Country:US
Mailing Address - Phone:718-805-2115
Mailing Address - Fax:
Practice Address - Street 1:27103 80TH AVE
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-1610
Practice Address - Country:US
Practice Address - Phone:718-470-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-23
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049186183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist