Provider Demographics
NPI:1710386479
Name:VIJ, VANISHA (PHARMD)
Entity Type:Individual
Prefix:
First Name:VANISHA
Middle Name:
Last Name:VIJ
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 VAN BUREN BLVD
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-2544
Mailing Address - Country:US
Mailing Address - Phone:951-689-7581
Mailing Address - Fax:951-689-7583
Practice Address - Street 1:5200 VAN BUREN BLVD
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-2544
Practice Address - Country:US
Practice Address - Phone:951-689-7581
Practice Address - Fax:951-689-7583
Is Sole Proprietor?:No
Enumeration Date:2014-08-19
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59867183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist