Provider Demographics
NPI:1730489881
Name:BHAYROO, ANEILL (RPH)
Entity Type:Individual
Prefix:DR
First Name:ANEILL
Middle Name:
Last Name:BHAYROO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CALISTOGA RD
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95409-3702
Mailing Address - Country:US
Mailing Address - Phone:707-539-2129
Mailing Address - Fax:707-539-2205
Practice Address - Street 1:100 CALISTOGA RD
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95409-3702
Practice Address - Country:US
Practice Address - Phone:707-539-2129
Practice Address - Fax:707-539-2205
Is Sole Proprietor?:No
Enumeration Date:2010-10-22
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57580183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist