Provider Demographics
NPI:1215218516
Name:BHAGAT, KOMAL V
Entity Type:Individual
Prefix:MRS
First Name:KOMAL
Middle Name:V
Last Name:BHAGAT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:446 BOSTON RD
Mailing Address - Street 2:
Mailing Address - City:BILLERICA
Mailing Address - State:MA
Mailing Address - Zip Code:01821-2714
Mailing Address - Country:US
Mailing Address - Phone:978-670-2188
Mailing Address - Fax:
Practice Address - Street 1:446 BOSTON RD
Practice Address - Street 2:
Practice Address - City:BILLERICA
Practice Address - State:MA
Practice Address - Zip Code:01821-2714
Practice Address - Country:US
Practice Address - Phone:978-670-2188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-31
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3597183500000X
MAPH27707183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist