Provider Demographics
NPI:1275136848
Name:VAYAS, RUPAL
Entity Type:Individual
Prefix:MRS
First Name:RUPAL
Middle Name:
Last Name:VAYAS
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 1:2360 LAKEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-1929
Mailing Address - Country:US
Mailing Address - Phone:732-905-8180
Mailing Address - Fax:
Practice Address - Street 1:2360 LAKEWOOD RD
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-1929
Practice Address - Country:US
Practice Address - Phone:732-905-8180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03304800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist