Provider Demographics
NPI:1831719129
Name:BHUKHAN, SHILPESH
Entity type:Individual
Prefix:MR
First Name:SHILPESH
Middle Name:
Last Name:BHUKHAN
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 1:713 TRANQUIL TRL
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-5944
Mailing Address - Country:US
Mailing Address - Phone:813-786-0378
Mailing Address - Fax:
Practice Address - Street 1:680 E BURLEIGH BLVD
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-2208
Practice Address - Country:US
Practice Address - Phone:352-253-0289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-16
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS51275183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist