Basic Information
Provider Information | |||||||||
NPI: | 1477654333 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BHATT-CHUGANI | ||||||||
FirstName: | HETAL | ||||||||
MiddleName: | PRABODH | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | PHARMD, BCACP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 3797 PENDLEBURY DR | ||||||||
Address2: |   | ||||||||
City: | PALM HARBOR | ||||||||
State: | FL | ||||||||
PostalCode: | 346852669 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7272446820 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 10000 BAY PINES BLVD | ||||||||
Address2: | BAY PINES VA HEALTHCARE SYSTEM PHARMACY SERVICE (119) | ||||||||
City: | BAY PINES | ||||||||
State: | FL | ||||||||
PostalCode: | 33744 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7273986661 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/25/2006 | ||||||||
LastUpdateDate: | 09/03/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | PS37727 | FL | N |   | Pharmacy Service Providers | Pharmacist |   | 1835P2201X | PS37727 | FL | N |   |   |   |   | 1835P0018X | PS37727 | FL | Y |   | Pharmacy Service Providers | Pharmacist | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
No ID Information.