Healthcare Provider Details

I. General information

NPI: 1760766992
Provider Name (Legal Business Name): HITESHKUMAR D BHIMANI PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2011
Last Update Date: 09/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3191 LANCASTER HWY STE H
RICHBURG SC
29729-9238
US

IV. Provider business mailing address

21790 21 MILE RD
MACOMB MI
48044-2974
US

V. Phone/Fax

Practice location:
  • Phone: 803-500-2998
  • Fax: 803-619-2211
Mailing address:
  • Phone: 586-469-0254
  • Fax: 586-469-1450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number37005
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: