Provider Demographics
NPI:1396182762
Name:BHAT, SHRADDHA R (RPH)
Entity Type:Individual
Prefix:
First Name:SHRADDHA
Middle Name:R
Last Name:BHAT
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 1:1414 SPRING GARDEN DR
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-6891
Mailing Address - Country:US
Mailing Address - Phone:919-638-2067
Mailing Address - Fax:
Practice Address - Street 1:10140 GREEN LEVEL CHURCH RD
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-8132
Practice Address - Country:US
Practice Address - Phone:919-460-4681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-26
Last Update Date:2013-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23053183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC23053OtherNC BOARD OF PHARMACY