Provider Demographics
NPI:1457957557
Name:TILVA, KAJAL PRAVINCHANDRA
Entity Type:Individual
Prefix:
First Name:KAJAL
Middle Name:PRAVINCHANDRA
Last Name:TILVA
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 1:6 STALLION CT
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-5341
Mailing Address - Country:US
Mailing Address - Phone:562-221-9225
Mailing Address - Fax:
Practice Address - Street 1:246 NORWOOD AVE
Practice Address - Street 2:
Practice Address - City:OAKHURST
Practice Address - State:NJ
Practice Address - Zip Code:07755-1747
Practice Address - Country:US
Practice Address - Phone:732-502-3154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-05
Last Update Date:2020-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03772100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist