Provider Demographics
NPI:1154496925
Name:DHADUK, JAYANTILAL VALLABHBHAI (RPH)
Entity Type:Individual
Prefix:MR
First Name:JAYANTILAL
Middle Name:VALLABHBHAI
Last Name:DHADUK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 HUDSON PL
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-4010
Mailing Address - Country:US
Mailing Address - Phone:973-893-9561
Mailing Address - Fax:718-882-6365
Practice Address - Street 1:LEROY PHARMACY
Practice Address - Street 2:358 E 204TH ST
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467
Practice Address - Country:US
Practice Address - Phone:718-882-5614
Practice Address - Fax:718-882-6365
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040473183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY040473OtherNY STATE LIC #
NY01871374Medicaid