Provider Demographics
NPI:1053605816
Name:MAVANI, BHUPENDRA
Entity type:Individual
Prefix:
First Name:BHUPENDRA
Middle Name:
Last Name:MAVANI
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 1:5900 LAKE WORTH RD
Mailing Address - Street 2:TARGET PHARMACY -1110
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-3212
Mailing Address - Country:US
Mailing Address - Phone:561-963-3391
Mailing Address - Fax:561-963-3391
Practice Address - Street 1:5900 LAKE WORTH RD
Practice Address - Street 2:TARGET PHARMACY -1110
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-3212
Practice Address - Country:US
Practice Address - Phone:561-963-3391
Practice Address - Fax:561-963-3391
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-08
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS40701183500000X
CA65446183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist