Provider Demographics
NPI:1376126342
Name:BHAKTA, JATIN ISHVAR (PHARMD)
Entity Type:Individual
Prefix:
First Name:JATIN
Middle Name:ISHVAR
Last Name:BHAKTA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15508 CROSSDALE AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-6231
Mailing Address - Country:US
Mailing Address - Phone:562-895-5960
Mailing Address - Fax:
Practice Address - Street 1:23811 HAWTHORNE BLVD
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5907
Practice Address - Country:US
Practice Address - Phone:310-375-0655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA82205183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist