Provider Demographics
NPI:1417551599
Name:BHAGUDAS, CHANDRADAT (RPH)
Entity Type:Individual
Prefix:
First Name:CHANDRADAT
Middle Name:
Last Name:BHAGUDAS
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 1:30 ADELINE PL
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-1302
Mailing Address - Country:US
Mailing Address - Phone:347-296-7037
Mailing Address - Fax:
Practice Address - Street 1:59 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-7383
Practice Address - Country:US
Practice Address - Phone:201-798-1889
Practice Address - Fax:201-798-1631
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03304300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist