Provider Demographics
NPI:1710545322
Name:DALVI, VIJAY S (RPH)
Entity Type:Individual
Prefix:
First Name:VIJAY
Middle Name:S
Last Name:DALVI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6055 N BRAWLEY AVE, APT 235
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722
Mailing Address - Country:US
Mailing Address - Phone:502-403-0628
Mailing Address - Fax:
Practice Address - Street 1:6055 N BRAWLEY AVE, APT 235
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722
Practice Address - Country:US
Practice Address - Phone:502-403-0628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-30
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH80030183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty