Provider Demographics
NPI:1205152667
Name:BHATT, PRAVIN (RPH)
Entity type:Individual
Prefix:MR
First Name:PRAVIN
Middle Name:
Last Name:BHATT
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 1:112 COUNTRY LN
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-3833
Mailing Address - Country:US
Mailing Address - Phone:973-246-4203
Mailing Address - Fax:
Practice Address - Street 1:112 COUNTRY LN
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-3833
Practice Address - Country:US
Practice Address - Phone:973-246-4203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-10
Last Update Date:2010-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028882183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist