Provider Demographics
NPI:1629391222
Name:PAGHDAL, VIJAY J (RPH, PHARMD)
Entity Type:Individual
Prefix:
First Name:VIJAY
Middle Name:J
Last Name:PAGHDAL
Suffix:
Gender:M
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5203A BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-7636
Mailing Address - Country:US
Mailing Address - Phone:718-562-6637
Mailing Address - Fax:
Practice Address - Street 1:5203A BROADWAY
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-7636
Practice Address - Country:US
Practice Address - Phone:718-562-6637
Practice Address - Fax:718-562-5031
Is Sole Proprietor?:No
Enumeration Date:2010-03-10
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049376183500000X
NJ28RI02812900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist