Provider Demographics
NPI:1417930264
Name:BRAHMBHATT, RAVAJI S (RPH)
Entity Type:Individual
Prefix:MR
First Name:RAVAJI
Middle Name:S
Last Name:BRAHMBHATT
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 1:81 POPLAR DRIVE
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-1357
Mailing Address - Country:US
Mailing Address - Phone:201-843-1442
Mailing Address - Fax:
Practice Address - Street 1:146 NAGLE AVENUE
Practice Address - Street 2:
Practice Address - City:N EW YORK
Practice Address - State:NY
Practice Address - Zip Code:10040-1437
Practice Address - Country:US
Practice Address - Phone:212-304-0649
Practice Address - Fax:212-304-2959
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030714183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist