Provider Demographics
NPI:1477158442
Name:MASALAWALA, DARSHAN JAYENDRA
Entity Type:Individual
Prefix:
First Name:DARSHAN
Middle Name:JAYENDRA
Last Name:MASALAWALA
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 1:2702 VALWOOD PKWY
Mailing Address - Street 2:
Mailing Address - City:FARMERS BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:75234-3530
Mailing Address - Country:US
Mailing Address - Phone:972-241-3862
Mailing Address - Fax:
Practice Address - Street 1:2702 VALWOOD PKWY
Practice Address - Street 2:
Practice Address - City:FARMERS BRANCH
Practice Address - State:TX
Practice Address - Zip Code:75234-3530
Practice Address - Country:US
Practice Address - Phone:972-241-3862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX57193183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist