Provider Demographics
NPI:1558660894
Name:VIBHAKAR, BHARAT M (RPH)
Entity Type:Individual
Prefix:MR
First Name:BHARAT
Middle Name:M
Last Name:VIBHAKAR
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:204 GREYSTONE DR
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30116-5106
Mailing Address - Country:US
Mailing Address - Phone:770-838-0439
Mailing Address - Fax:770-489-6511
Practice Address - Street 1:2710 HIGHWAY 92
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-5106
Practice Address - Country:US
Practice Address - Phone:770-852-1561
Practice Address - Fax:770-489-6511
Is Sole Proprietor?:No
Enumeration Date:2011-03-25
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH018058183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist