Provider Demographics
NPI:1780357509
Name:VAGHASIYA, MAYANK VALLABH (PHARMD)
Entity type:Individual
Prefix:
First Name:MAYANK
Middle Name:VALLABH
Last Name:VAGHASIYA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6323 BALTIMORE NATIONAL PIKE
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-3902
Mailing Address - Country:US
Mailing Address - Phone:410-744-0306
Mailing Address - Fax:
Practice Address - Street 1:6323 BALTIMORE NATIONAL PIKE
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-3902
Practice Address - Country:US
Practice Address - Phone:941-505-8882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-28
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS62764183500000X
MD28530183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist