Provider Demographics
NPI:1053952747
Name:BHANDER, BIRPAUL (RPH)
Entity type:Individual
Prefix:MR
First Name:BIRPAUL
Middle Name:
Last Name:BHANDER
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 1:645 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DEFOREST
Mailing Address - State:WI
Mailing Address - Zip Code:53532-1421
Mailing Address - Country:US
Mailing Address - Phone:608-846-4736
Mailing Address - Fax:608-846-6892
Practice Address - Street 1:645 S MAIN ST
Practice Address - Street 2:
Practice Address - City:DEFOREST
Practice Address - State:WI
Practice Address - Zip Code:53532-1421
Practice Address - Country:US
Practice Address - Phone:608-846-4736
Practice Address - Fax:608-846-6892
Is Sole Proprietor?:No
Enumeration Date:2019-10-03
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI19774-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist