Provider Demographics
NPI:1679057095
Name:COELHO, VIRAJ S (RPH)
Entity Type:Individual
Prefix:
First Name:VIRAJ
Middle Name:S
Last Name:COELHO
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 1:45 STEPHEN DR
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-5723
Mailing Address - Country:US
Mailing Address - Phone:516-942-7480
Mailing Address - Fax:
Practice Address - Street 1:45 STEPHEN DR
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-5723
Practice Address - Country:US
Practice Address - Phone:516-942-7480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-21
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041893183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist