Provider Demographics
NPI:1225390057
Name:BHATT, AVANI (RPH)
Entity Type:Individual
Prefix:
First Name:AVANI
Middle Name:
Last Name:BHATT
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 1:40580 ALBRAE ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-2448
Mailing Address - Country:US
Mailing Address - Phone:510-440-8068
Mailing Address - Fax:510-440-8068
Practice Address - Street 1:40580 ALBRAE ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-2448
Practice Address - Country:US
Practice Address - Phone:510-440-8068
Practice Address - Fax:510-440-8068
Is Sole Proprietor?:No
Enumeration Date:2012-06-07
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA68649183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist