Provider Demographics
NPI:1225650013
Name:BHAGAT, NIKHIL D (RPH)
Entity Type:Individual
Prefix:
First Name:NIKHIL
Middle Name:D
Last Name:BHAGAT
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 1:375 EUREKA RD STE A
Mailing Address - Street 2:
Mailing Address - City:WYANDOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48192-5839
Mailing Address - Country:US
Mailing Address - Phone:734-720-0929
Mailing Address - Fax:855-476-3776
Practice Address - Street 1:375 EUREKA RD STE A
Practice Address - Street 2:
Practice Address - City:WYANDOTTE
Practice Address - State:MI
Practice Address - Zip Code:48192-5839
Practice Address - Country:US
Practice Address - Phone:734-720-0929
Practice Address - Fax:855-476-3776
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-14
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302037059183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist