Provider Demographics
NPI:1710490024
Name:BHAGAT, SANDIPKUMAR S
Entity Type:Individual
Prefix:
First Name:SANDIPKUMAR
Middle Name:S
Last Name:BHAGAT
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 1:130 GAINES SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-3118
Mailing Address - Country:US
Mailing Address - Phone:706-850-2133
Mailing Address - Fax:
Practice Address - Street 1:130 GAINES SCHOOL RD
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605-3118
Practice Address - Country:US
Practice Address - Phone:706-850-2133
Practice Address - Fax:706-850-2133
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-08
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH025898183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist