Provider Demographics
NPI:1841893567
Name:BHAGAT, KRUNAL
Entity type:Individual
Prefix:
First Name:KRUNAL
Middle Name:
Last Name:BHAGAT
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 1:9368 RIVER OTTER DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-8924
Mailing Address - Country:US
Mailing Address - Phone:954-980-4925
Mailing Address - Fax:
Practice Address - Street 1:2403 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-4904
Practice Address - Country:US
Practice Address - Phone:239-332-3050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS47390183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist