Provider Demographics
NPI:1396438909
Name:BHAKTA, MYLA
Entity type:Individual
Prefix:
First Name:MYLA
Middle Name:
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 1:7909 AVENUE N
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-6954
Mailing Address - Country:US
Mailing Address - Phone:806-204-1221
Mailing Address - Fax:
Practice Address - Street 1:1411 W AMERICAN BLVD
Practice Address - Street 2:
Practice Address - City:MULESHOE
Practice Address - State:TX
Practice Address - Zip Code:79347-3123
Practice Address - Country:US
Practice Address - Phone:806-272-7511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72316183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist