Provider Demographics
NPI:1548562101
Name:BHAGAT, TEJAS (PHARMD)
Entity Type:Individual
Prefix:
First Name:TEJAS
Middle Name:
Last Name:BHAGAT
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5408 CREEK RIDGE LN
Mailing Address - Street 2:APT # O
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-3865
Mailing Address - Country:US
Mailing Address - Phone:919-720-0991
Mailing Address - Fax:
Practice Address - Street 1:1910 FALLS VALLEY DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-3445
Practice Address - Country:US
Practice Address - Phone:919-844-5440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21175183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist