Provider Demographics
NPI:1659646842
Name:DHADUK, BHAVIN RATILAL
Entity Type:Individual
Prefix:
First Name:BHAVIN
Middle Name:RATILAL
Last Name:DHADUK
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 1:6801 N US HIGHWAY 1 STE 1
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32927-5095
Mailing Address - Country:US
Mailing Address - Phone:321-637-0911
Mailing Address - Fax:321-639-0856
Practice Address - Street 1:6801 N US HIGHWAY 1 STE 1
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32927-5095
Practice Address - Country:US
Practice Address - Phone:321-637-0911
Practice Address - Fax:321-639-0856
Is Sole Proprietor?:No
Enumeration Date:2012-03-20
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS47008183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS47008OtherPHARMACIST LICENCE