Provider Demographics
NPI:1154957926
Name:KALAVADIYA, BHUMIT (PHARMD)
Entity type:Individual
Prefix:
First Name:BHUMIT
Middle Name:
Last Name:KALAVADIYA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8375 W PONTIAC DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-1412
Mailing Address - Country:US
Mailing Address - Phone:623-882-5687
Mailing Address - Fax:
Practice Address - Street 1:8375 W PONTIAC DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-1412
Practice Address - Country:US
Practice Address - Phone:623-882-5687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-12
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS024493183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist