Provider Demographics
NPI:1790385870
Name:SANYAL, GAURAB (RPH)
Entity Type:Individual
Prefix:MR
First Name:GAURAB
Middle Name:
Last Name:SANYAL
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 1:100 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08835-1358
Mailing Address - Country:US
Mailing Address - Phone:908-575-8928
Mailing Address - Fax:908-575-8903
Practice Address - Street 1:100 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MANVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08835-1358
Practice Address - Country:US
Practice Address - Phone:908-575-8928
Practice Address - Fax:908-575-8903
Is Sole Proprietor?:No
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02427400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist