Provider Demographics
NPI:1891127007
Name:VIBHAKAR, HEETA (PHARM D)
Entity Type:Individual
Prefix:
First Name:HEETA
Middle Name:
Last Name:VIBHAKAR
Suffix:
Gender:F
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 1:609 S NEW HOPE RD
Mailing Address - Street 2:CLUB COMMONS, SUITE 200-B
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-4876
Mailing Address - Country:US
Mailing Address - Phone:678-209-1360
Mailing Address - Fax:
Practice Address - Street 1:609 S NEW HOPE RD
Practice Address - Street 2:CLUB COMMONS, SUITE 200-B
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-4876
Practice Address - Country:US
Practice Address - Phone:678-209-1360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-30
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23451183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist