Provider Demographics
NPI:1962848101
Name:BHAKTA, DEEPA DINKAR
Entity Type:Individual
Prefix:
First Name:DEEPA
Middle Name:DINKAR
Last Name:BHAKTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 GRAPEVINE MILLS PKWY
Mailing Address - Street 2:APT 3713
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-1989
Mailing Address - Country:US
Mailing Address - Phone:806-543-7643
Mailing Address - Fax:
Practice Address - Street 1:3900 GRAPEVINE MILLS PKWY
Practice Address - Street 2:APT 3713
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-1989
Practice Address - Country:US
Practice Address - Phone:806-543-7643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-15
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45029183500000X
NJ28RI03552000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist