Provider Demographics
NPI:1740672690
Name:THYVALAPPIL, MARTIN (PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:
Last Name:THYVALAPPIL
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:197 CAHILL CROSS RD
Mailing Address - Street 2:316
Mailing Address - City:WEST MILFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07480-1947
Mailing Address - Country:US
Mailing Address - Phone:973-728-4600
Mailing Address - Fax:973-728-2103
Practice Address - Street 1:197 CAHILL CROSS RD
Practice Address - Street 2:316
Practice Address - City:WEST MILFORD
Practice Address - State:NJ
Practice Address - Zip Code:07480-1947
Practice Address - Country:US
Practice Address - Phone:973-728-4600
Practice Address - Fax:973-728-2103
Is Sole Proprietor?:No
Enumeration Date:2015-03-02
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03250900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist