Provider Demographics
NPI:1477934255
Name:BHATNAGAR, RAGHAVENDRA (RPH)
Entity Type:Individual
Prefix:
First Name:RAGHAVENDRA
Middle Name:
Last Name:BHATNAGAR
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 1:6951 SAINT AUGUSTINE RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-2819
Mailing Address - Country:US
Mailing Address - Phone:904-448-8181
Mailing Address - Fax:904-448-6662
Practice Address - Street 1:6951 SAINT AUGUSTINE RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-2819
Practice Address - Country:US
Practice Address - Phone:904-448-8181
Practice Address - Fax:904-448-6662
Is Sole Proprietor?:No
Enumeration Date:2015-06-17
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS20469183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL308505OtherNABP