Provider Demographics
NPI:1669794509
Name:DALAL, VIPULKUMAR R (RPH)
Entity type:Individual
Prefix:MR
First Name:VIPULKUMAR
Middle Name:R
Last Name:DALAL
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 1:17 RUBAR DR
Mailing Address - Street 2:
Mailing Address - City:PARLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08859-2507
Mailing Address - Country:US
Mailing Address - Phone:732-238-4646
Mailing Address - Fax:732-257-1440
Practice Address - Street 1:1422 W PROSPECT ST
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816
Practice Address - Country:US
Practice Address - Phone:732-238-4646
Practice Address - Fax:732-257-1440
Is Sole Proprietor?:No
Enumeration Date:2010-02-19
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02053500183500000X
NY040468183500000X
PARP-037954-R183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist