Provider Demographics
NPI:1366733495
Name:PATEL, BHAVNA S (BSC)
Entity type:Individual
Prefix:MS
First Name:BHAVNA
Middle Name:S
Last Name:PATEL
Suffix:
Gender:F
Credentials:BSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 SHADOW RIDGE PL
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-4316
Mailing Address - Country:US
Mailing Address - Phone:919-967-8167
Mailing Address - Fax:
Practice Address - Street 1:200 N LASALLE ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-3013
Practice Address - Country:US
Practice Address - Phone:919-383-0885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-24
Last Update Date:2011-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14695183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist