Provider Demographics
NPI:1134447626
Name:SHUKLA, BHARGAV K
Entity type:Individual
Prefix:
First Name:BHARGAV
Middle Name:K
Last Name:SHUKLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 HADLEY CENTER DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080-1140
Mailing Address - Country:US
Mailing Address - Phone:908-444-2024
Mailing Address - Fax:908-444-2024
Practice Address - Street 1:5000 HADLEY CENTER DR
Practice Address - Street 2:
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080-1140
Practice Address - Country:US
Practice Address - Phone:908-444-2024
Practice Address - Fax:908-444-2024
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-10
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02509800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist