Provider Demographics
NPI:1629678206
Name:BHAT, MEENAKSHI
Entity Type:Individual
Prefix:
First Name:MEENAKSHI
Middle Name:
Last Name:BHAT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MEENA
Other - Middle Name:
Other - Last Name:BHAT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1920 E MARKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46901-6236
Mailing Address - Country:US
Mailing Address - Phone:765-456-3641
Mailing Address - Fax:765-457-3467
Practice Address - Street 1:1920 E MARKLAND AVE
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901-6236
Practice Address - Country:US
Practice Address - Phone:765-456-3641
Practice Address - Fax:765-457-3467
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-31
Last Update Date:2020-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26023040A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist