Provider Demographics
NPI:1194046060
Name:MANOHARAN, VIJAYA KUMAR (RPH)
Entity Type:Individual
Prefix:MR
First Name:VIJAYA KUMAR
Middle Name:
Last Name:MANOHARAN
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 1:16 ROUTE 59
Mailing Address - Street 2:
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-2972
Mailing Address - Country:US
Mailing Address - Phone:845-358-1589
Mailing Address - Fax:845-353-2673
Practice Address - Street 1:16 ROUTE 59
Practice Address - Street 2:
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-2913
Practice Address - Country:US
Practice Address - Phone:845-358-1589
Practice Address - Fax:453-532-6738
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-15
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03231800183500000X
NY057536183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist