Provider Demographics
NPI:1396038709
Name:VYAS, BHASKAR R
Entity Type:Individual
Prefix:MR
First Name:BHASKAR
Middle Name:R
Last Name:VYAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 GALE CT
Mailing Address - Street 2:
Mailing Address - City:N PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-1033
Mailing Address - Country:US
Mailing Address - Phone:401-353-6321
Mailing Address - Fax:
Practice Address - Street 1:14 GALE CT
Practice Address - Street 2:
Practice Address - City:N PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-1033
Practice Address - Country:US
Practice Address - Phone:401-353-6321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-17
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRPH02188183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist