Provider Demographics
NPI:1689093858
Name:BHADIYADARA, KRUNAL
Entity Type:Individual
Prefix:
First Name:KRUNAL
Middle Name:
Last Name:BHADIYADARA
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 1:305 N JUDD PKWY NE
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-2370
Mailing Address - Country:US
Mailing Address - Phone:919-557-8300
Mailing Address - Fax:919-557-8308
Practice Address - Street 1:305 N JUDD PKWY NE
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-2370
Practice Address - Country:US
Practice Address - Phone:919-557-8300
Practice Address - Fax:919-557-8308
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23955183500000X
VA0202212387183500000X
TX54368183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist