Provider Demographics
NPI:1871761833
Name:KUSUMALAYAM, JAYA J (RPH)
Entity type:Individual
Prefix:
First Name:JAYA
Middle Name:J
Last Name:KUSUMALAYAM
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 ADAMS LN
Mailing Address - Street 2:
Mailing Address - City:AIRMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10901-7114
Mailing Address - Country:US
Mailing Address - Phone:845-357-1500
Mailing Address - Fax:845-369-7759
Practice Address - Street 1:5 INDIAN ROCK
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-4907
Practice Address - Country:US
Practice Address - Phone:845-357-1500
Practice Address - Fax:845-369-7759
Is Sole Proprietor?:No
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045106-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist