Healthcare Provider Details

I. General information

NPI: 1700179348
Provider Name (Legal Business Name): DHARMESH G BHAKTA RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2011
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6271 CAROLINA COMMONS DR
INDIAN LAND SC
29707-5980
US

IV. Provider business mailing address

6271 CAROLINA COMMONS DR
INDIAN LAND SC
29707-5980
US

V. Phone/Fax

Practice location:
  • Phone: 803-802-5400
  • Fax:
Mailing address:
  • Phone: 803-802-5400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number12530
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number36526
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: