Provider Demographics
NPI:1770231151
Name:SINGANAMALA, BHAVANA (BPHARM)
Entity Type:Individual
Prefix:
First Name:BHAVANA
Middle Name:
Last Name:SINGANAMALA
Suffix:
Gender:F
Credentials:BPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 VALLEY VISTA DR
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-5416
Mailing Address - Country:US
Mailing Address - Phone:860-997-7050
Mailing Address - Fax:
Practice Address - Street 1:3600 CONFLANS RD # 210
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-6324
Practice Address - Country:US
Practice Address - Phone:469-340-4030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-14
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66641183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist