Healthcare Provider Details

I. General information

NPI: 1134898174
Provider Name (Legal Business Name): BISMITA DHAKAL POKHREL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2021
Last Update Date: 09/13/2021
Certification Date: 09/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395 E VAN FLEET DR
BARTOW FL
33830-3833
US

IV. Provider business mailing address

2187 BLUE HIGHLANDS DR
LAKELAND FL
33811-1017
US

V. Phone/Fax

Practice location:
  • Phone: 863-533-6669
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS62314
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: