Provider Demographics
NPI:1285816611
Name:MERCHANT, JASVIN A (RPH)
Entity Type:Individual
Prefix:
First Name:JASVIN
Middle Name:A
Last Name:MERCHANT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 DEAMER CT
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTN STA
Mailing Address - State:NY
Mailing Address - Zip Code:11746-3427
Mailing Address - Country:US
Mailing Address - Phone:718-997-0017
Mailing Address - Fax:
Practice Address - Street 1:325 ROUTE 110
Practice Address - Street 2:
Practice Address - City:HUNTINGTN STA
Practice Address - State:NY
Practice Address - Zip Code:11746-4149
Practice Address - Country:US
Practice Address - Phone:631-271-2525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046673183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01562505Medicaid