Provider Demographics
NPI:1942485263
Name:LAVU, VIJAYAKUMAR (BSPHARM)
Entity Type:Individual
Prefix:
First Name:VIJAYAKUMAR
Middle Name:
Last Name:LAVU
Suffix:
Gender:M
Credentials:BSPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4751 ONONDAGA BLVD
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13219-3315
Mailing Address - Country:US
Mailing Address - Phone:315-476-2141
Mailing Address - Fax:315-475-8632
Practice Address - Street 1:4751 ONONDAGA BLVD
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13219-3315
Practice Address - Country:US
Practice Address - Phone:315-476-2141
Practice Address - Fax:315-475-8632
Is Sole Proprietor?:No
Enumeration Date:2008-01-05
Last Update Date:2008-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030521183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY030521OtherLICENSE