Provider Demographics
NPI:1750795357
Name:KYADA, MINAXI
Entity type:Individual
Prefix:
First Name:MINAXI
Middle Name:
Last Name:KYADA
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 1:225 LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:FRAZER
Mailing Address - State:PA
Mailing Address - Zip Code:19355-1875
Mailing Address - Country:US
Mailing Address - Phone:610-640-9641
Mailing Address - Fax:610-640-4239
Practice Address - Street 1:225 LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:FRAZER
Practice Address - State:PA
Practice Address - Zip Code:19355-1875
Practice Address - Country:US
Practice Address - Phone:610-264-0964
Practice Address - Fax:610-640-4239
Is Sole Proprietor?:No
Enumeration Date:2014-06-12
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP440309183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist