Provider Demographics
NPI:1215214358
Name:MEDA, AMULYA
Entity Type:Individual
Prefix:MRS
First Name:AMULYA
Middle Name:
Last Name:MEDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 MILL ST
Mailing Address - Street 2:UNIT 7
Mailing Address - City:NEWTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07860-1457
Mailing Address - Country:US
Mailing Address - Phone:973-940-0434
Mailing Address - Fax:973-940-0439
Practice Address - Street 1:55 MILL ST
Practice Address - Street 2:UNIT 7
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860-1457
Practice Address - Country:US
Practice Address - Phone:973-940-0434
Practice Address - Fax:973-940-0439
Is Sole Proprietor?:No
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03055800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist