Provider Demographics
NPI:1760942254
Name:BHAKTA, SAGAR R (PHARMD)
Entity Type:Individual
Prefix:
First Name:SAGAR
Middle Name:R
Last Name:BHAKTA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5043 SNOWBERRY DR
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-0759
Mailing Address - Country:US
Mailing Address - Phone:931-808-7931
Mailing Address - Fax:
Practice Address - Street 1:25620 BARTON RD
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3110
Practice Address - Country:US
Practice Address - Phone:909-796-8308
Practice Address - Fax:909-796-3048
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-21
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80347183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty