Provider Demographics
NPI:1346669108
Name:DAVE, BHUPEN (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:BHUPEN
Middle Name:
Last Name:DAVE
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 EAST CENTRAL AVENUE
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977
Mailing Address - Country:US
Mailing Address - Phone:845-352-0490
Mailing Address - Fax:845-352-0524
Practice Address - Street 1:180 E. CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:SPRINGVALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977
Practice Address - Country:US
Practice Address - Phone:845-352-0490
Practice Address - Fax:845-352-0524
Is Sole Proprietor?:No
Enumeration Date:2014-04-09
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035356-1183500000X
NJ28RI02007900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist