Healthcare Provider Details

I. General information

NPI: 1083220552
Provider Name (Legal Business Name): DHAVALKUMAR BHALODIA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2020
Last Update Date: 09/21/2020
Certification Date: 09/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 W LANCASTER RD
ORLANDO FL
32809-5994
US

IV. Provider business mailing address

11758 CHATEAUBRIAND AVE
ORLANDO FL
32836-8805
US

V. Phone/Fax

Practice location:
  • Phone: 407-855-4770
  • Fax: 407-855-4772
Mailing address:
  • Phone: 201-314-3158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS44597
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: