Provider Demographics
NPI:1619386893
Name:THAKRAR, BHAVESH
Entity Type:Individual
Prefix:
First Name:BHAVESH
Middle Name:
Last Name:THAKRAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 GARRY RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CINNAMINSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08077-2595
Mailing Address - Country:US
Mailing Address - Phone:856-267-0528
Mailing Address - Fax:856-267-0529
Practice Address - Street 1:2200 GARRY RD
Practice Address - Street 2:SUITE 1
Practice Address - City:CINNAMINSON
Practice Address - State:NJ
Practice Address - Zip Code:08077-2595
Practice Address - Country:US
Practice Address - Phone:856-267-0528
Practice Address - Fax:856-267-0529
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-12
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP440870183500000X
NJ28RI02669900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist