Provider Demographics
NPI:1912542002
Name:MAA BHAWANI INC
Entity Type:Organization
Organization Name:MAA BHAWANI INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAJESH
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:352-270-2281
Mailing Address - Street 1:2432 W ELM BLOSSOM ST
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:FL
Mailing Address - Zip Code:34465-3037
Mailing Address - Country:US
Mailing Address - Phone:352-270-2281
Mailing Address - Fax:855-829-8668
Practice Address - Street 1:3791 N LECANTO HWY
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:FL
Practice Address - Zip Code:34465-3559
Practice Address - Country:US
Practice Address - Phone:352-527-3111
Practice Address - Fax:855-829-8668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-12
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy