Provider Demographics
NPI:1720379852
Name:BHAGAT, SAMIR (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:SAMIR
Middle Name:
Last Name:BHAGAT
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2998 NORTHLINE AVE
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-7800
Mailing Address - Country:US
Mailing Address - Phone:336-632-0448
Mailing Address - Fax:336-854-6039
Practice Address - Street 1:2998 NORTHLINE AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-7800
Practice Address - Country:US
Practice Address - Phone:336-632-0448
Practice Address - Fax:336-854-6039
Is Sole Proprietor?:No
Enumeration Date:2011-04-24
Last Update Date:2011-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18439183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist