Provider Demographics
NPI:1386242949
Name:BHALAVAT, NEIR
Entity type:Individual
Prefix:
First Name:NEIR
Middle Name:
Last Name:BHALAVAT
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 1:5890 N BELT W
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62226-4618
Mailing Address - Country:US
Mailing Address - Phone:217-553-7087
Mailing Address - Fax:
Practice Address - Street 1:1201 CAMP JACKSON RD
Practice Address - Street 2:
Practice Address - City:CAHOKIA
Practice Address - State:IL
Practice Address - Zip Code:62206-2231
Practice Address - Country:US
Practice Address - Phone:618-332-2904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051303498183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL051303498OtherILLINOIS PHARMACIST LICENSE