Provider Demographics
NPI:1932700325
Name:VYAS, NIYANTA
Entity Type:Individual
Prefix:
First Name:NIYANTA
Middle Name:
Last Name:VYAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4803 CLOVIS CT
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76016-2968
Mailing Address - Country:US
Mailing Address - Phone:817-395-3594
Mailing Address - Fax:
Practice Address - Street 1:WALMART 1118
Practice Address - Street 2:12300 LAKE JUNE RD
Practice Address - City:BALCH SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75180
Practice Address - Country:US
Practice Address - Phone:972-286-0180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist