Provider Demographics
NPI:1437764578
Name:SAMUEL, BAKHTAVER JAVED (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:BAKHTAVER
Middle Name:JAVED
Last Name:SAMUEL
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:813 EDMONTON DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-2580
Mailing Address - Country:US
Mailing Address - Phone:972-832-3966
Mailing Address - Fax:
Practice Address - Street 1:1325 W WHITE ST
Practice Address - Street 2:
Practice Address - City:ANNA
Practice Address - State:TX
Practice Address - Zip Code:75409-5007
Practice Address - Country:US
Practice Address - Phone:972-924-4220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67098183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist