Provider Demographics
NPI:1225639693
Name:GRACIAS, VIJAYA J
Entity Type:Individual
Prefix:
First Name:VIJAYA
Middle Name:J
Last Name:GRACIAS
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 1:23 STRATFORD RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02465-1816
Mailing Address - Country:US
Mailing Address - Phone:847-722-0414
Mailing Address - Fax:
Practice Address - Street 1:121 WORCESTER RD
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701-5348
Practice Address - Country:US
Practice Address - Phone:508-872-4265
Practice Address - Fax:508-872-0314
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH232836183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist