Provider Demographics
NPI:1801448253
Name:MAKVANA, BHAVIN
Entity type:Individual
Prefix:
First Name:BHAVIN
Middle Name:
Last Name:MAKVANA
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 1:2111 CAMPBELLTON RD SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30311-4605
Mailing Address - Country:US
Mailing Address - Phone:404-755-4232
Mailing Address - Fax:404-753-0032
Practice Address - Street 1:2111 CAMPBELLTON RD SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30311-4605
Practice Address - Country:US
Practice Address - Phone:404-755-4232
Practice Address - Fax:404-753-0032
Is Sole Proprietor?:No
Enumeration Date:2019-07-15
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH031278183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARPH031278OtherREGISTERED PHARMACIST