Provider Demographics
NPI:1073762753
Name:BULSARA, BHAVNA (RPH)
Entity Type:Individual
Prefix:
First Name:BHAVNA
Middle Name:
Last Name:BULSARA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 GREENWAY E
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-2221
Mailing Address - Country:US
Mailing Address - Phone:516-873-0786
Mailing Address - Fax:
Practice Address - Street 1:54 GREENWAY E
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-2221
Practice Address - Country:US
Practice Address - Phone:516-873-0786
Practice Address - Fax:516-873-0786
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047655183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist