Healthcare Provider Details

I. General information

NPI: 1326460791
Provider Name (Legal Business Name): RITESH BHAVSAR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2014
Last Update Date: 01/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 N 75TH AVE
PHOENIX AZ
85035-3200
US

IV. Provider business mailing address

2020 N 75TH AVE
PHOENIX AZ
85035-3200
US

V. Phone/Fax

Practice location:
  • Phone: 623-849-4055
  • Fax: 623-846-7279
Mailing address:
  • Phone: 623-849-4055
  • Fax: 623-846-7279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS017574
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: