Provider Demographics
NPI:1083220552
Name:BHALODIA, DHAVALKUMAR
Entity Type:Individual
Prefix:
First Name:DHAVALKUMAR
Middle Name:
Last Name:BHALODIA
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 1:11758 CHATEAUBRIAND AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32836-8805
Mailing Address - Country:US
Mailing Address - Phone:201-314-3158
Mailing Address - Fax:
Practice Address - Street 1:717 W LANCASTER RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-5994
Practice Address - Country:US
Practice Address - Phone:407-855-4770
Practice Address - Fax:407-855-4772
Is Sole Proprietor?:No
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS44597183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist