Provider Demographics
NPI:1053601773
Name:BHATT, BHAVESH C (PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:BHAVESH
Middle Name:C
Last Name:BHATT
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12A DAYTONA AVE
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-2034
Mailing Address - Country:US
Mailing Address - Phone:856-366-9990
Mailing Address - Fax:
Practice Address - Street 1:855 NORTH MAIN STREET
Practice Address - Street 2:RITE AID PHARMACY
Practice Address - City:PLEASANTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08232
Practice Address - Country:US
Practice Address - Phone:609-407-6562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-14
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03408700183500000X
TX49663183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist