Provider Demographics
NPI:1528651569
Name:BHATT, NEHA
Entity type:Individual
Prefix:
First Name:NEHA
Middle Name:
Last Name:BHATT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18325 PATTI LN
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-3869
Mailing Address - Country:US
Mailing Address - Phone:414-581-5556
Mailing Address - Fax:
Practice Address - Street 1:5301 S 76TH ST
Practice Address - Street 2:
Practice Address - City:GREENDALE
Practice Address - State:WI
Practice Address - Zip Code:53129-1128
Practice Address - Country:US
Practice Address - Phone:414-978-9016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-19
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17799-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist