Provider Demographics
NPI:1801057260
Name:BHAKTA, KAMAL D (PHARMD,RPH,MBA)
Entity type:Individual
Prefix:DR
First Name:KAMAL
Middle Name:D
Last Name:BHAKTA
Suffix:
Gender:M
Credentials:PHARMD,RPH,MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4015 22ND PL
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1119
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4000 24TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1894
Practice Address - Country:US
Practice Address - Phone:806-725-6770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-18
Last Update Date:2020-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174H00000X
NMRP00007066183500000X
AZS017078183500000X
TX45446183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No174H00000XOther Service ProvidersHealth Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
165940OtherNABP
TXTX PRECEPTOROtherTX PRECEPTOR
AZAZ PRECEPTOROtherAZ PRECEPTOR
NM1351OtherNM PRECEPTOR