Provider Demographics
NPI:1043962087
Name:MALAVIYA, VIPUL
Entity type:Individual
Prefix:
First Name:VIPUL
Middle Name:
Last Name:MALAVIYA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-3673
Mailing Address - Country:US
Mailing Address - Phone:973-751-0307
Mailing Address - Fax:973-751-0307
Practice Address - Street 1:122 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-3673
Practice Address - Country:US
Practice Address - Phone:973-751-0307
Practice Address - Fax:973-751-0307
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-20
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02957100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist