Provider Demographics
NPI:1821459462
Name:BHAKTA, JAGDISH (RPH)
Entity Type:Individual
Prefix:MR
First Name:JAGDISH
Middle Name:
Last Name:BHAKTA
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 1:6051 VALPARAISO WAY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-4870
Mailing Address - Country:US
Mailing Address - Phone:210-468-5444
Mailing Address - Fax:
Practice Address - Street 1:502 NEW VALLEY HI DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78227-4394
Practice Address - Country:US
Practice Address - Phone:210-673-0817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-10
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-12951183500000X
TX39305183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist