Provider Demographics
NPI:1568783561
Name:BHAKTA, PRIYA JAY (PHARMACIST)
Entity Type:Individual
Prefix:MRS
First Name:PRIYA
Middle Name:JAY
Last Name:BHAKTA
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 PEBBLE BEACH DR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:TX
Mailing Address - Zip Code:78374-4005
Mailing Address - Country:US
Mailing Address - Phone:361-758-2135
Mailing Address - Fax:361-758-8702
Practice Address - Street 1:335 PEBBLE BEACH DR
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:TX
Practice Address - Zip Code:78374-4005
Practice Address - Country:US
Practice Address - Phone:361-758-2135
Practice Address - Fax:361-758-8702
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-14
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33220183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist