Provider Demographics
NPI:1619150083
Name:BISHT, BHUPESH (BPHARMACY)
Entity Type:Individual
Prefix:
First Name:BHUPESH
Middle Name:
Last Name:BISHT
Suffix:
Gender:M
Credentials:BPHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8525 120TH ST
Mailing Address - Street 2:APT # LD
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-3131
Mailing Address - Country:US
Mailing Address - Phone:718-846-4962
Mailing Address - Fax:
Practice Address - Street 1:16502 BAISLEY BLVD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-2517
Practice Address - Country:US
Practice Address - Phone:718-525-7642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-08
Last Update Date:2007-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051704183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01294288Medicaid