Healthcare Provider Details

I. General information

NPI: 1689093858
Provider Name (Legal Business Name): KRUNAL BHADIYADARA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 E GREER ST
HONEA PATH SC
29654-1818
US

IV. Provider business mailing address

309 E GREER ST
HONEA PATH SC
29654-1818
US

V. Phone/Fax

Practice location:
  • Phone: 864-369-5337
  • Fax: 864-210-9006
Mailing address:
  • Phone: 864-369-5337
  • Fax: 864-210-9006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number23955
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202212387
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number54368
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number42182
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: