Provider Demographics
NPI:1376956391
Name:PANSARA, BHAVESHKUMAR
Entity Type:Individual
Prefix:
First Name:BHAVESHKUMAR
Middle Name:
Last Name:PANSARA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 STATE HIGHWAY 121 APT 205
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76039-4062
Mailing Address - Country:US
Mailing Address - Phone:817-733-1629
Mailing Address - Fax:
Practice Address - Street 1:2400 STATE HIGHWAY 121 APT 205
Practice Address - Street 2:
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76039-4062
Practice Address - Country:US
Practice Address - Phone:817-733-1629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-06
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX547071835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1993291OtherEMPLOYEE ID