Provider Demographics
NPI:1669842977
Name:BHAKTA, SAPAN (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:SAPAN
Middle Name:
Last Name:BHAKTA
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3831 HUGHES AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-6834
Mailing Address - Country:US
Mailing Address - Phone:310-204-1111
Mailing Address - Fax:310-204-0295
Practice Address - Street 1:3831 HUGHES AVE STE 100
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-6834
Practice Address - Country:US
Practice Address - Phone:310-204-1111
Practice Address - Fax:310-204-0295
Is Sole Proprietor?:No
Enumeration Date:2015-09-29
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6112270001Medicare NSC