Provider Demographics
NPI:1225486343
Name:VYAS, PURVI (PHARMD)
Entity Type:Individual
Prefix:
First Name:PURVI
Middle Name:
Last Name:VYAS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3110 HENRY LN
Mailing Address - Street 2:
Mailing Address - City:LAKE IN THE HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60156-6762
Mailing Address - Country:US
Mailing Address - Phone:847-409-0637
Mailing Address - Fax:
Practice Address - Street 1:696 NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:IL
Practice Address - Zip Code:60013-2073
Practice Address - Country:US
Practice Address - Phone:847-639-3697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-31
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051290483183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist