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General NPI Number Information
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NPI Number | 1003104779
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Entity Type | Organization
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Legal Business Name | MAA BHAWANI INC
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Dates
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Enumeration Date | 07/15/2011
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Last Update Date | 02/28/2017
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Provider Practice Location Address
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Address Line | 5691 S SUNCOAST BLVD
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City | HOMOSASSA
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State | FL
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Zip | 34446-2605
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Country | US
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Telephone | 352-628-0096
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Fax | 352-527-2629
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Provider Business Mailing Address
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Address Line | 3791 N LECANTO HWY
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City | BEVERLY HILLS
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State | FL
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Zip | 34465-3559
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Country | US
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Telephone | 352-527-3111
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Fax | 352-527-2629
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | RAJESH PATEL
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Credential | PHARM D
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Telephone | 352-527-3111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH25878
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License Number State | FL
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