Provider Demographics
NPI:1801944681
Name:GAYAM, HEMAGIRI R (RPH)
Entity type:Individual
Prefix:MR
First Name:HEMAGIRI
Middle Name:R
Last Name:GAYAM
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 1:201 BENNINGTON TER
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-1335
Mailing Address - Country:US
Mailing Address - Phone:201-880-1601
Mailing Address - Fax:
Practice Address - Street 1:1220 MORRIS AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-3117
Practice Address - Country:US
Practice Address - Phone:718-293-2233
Practice Address - Fax:718-293-1167
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048950183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY048950OtherPHARMACIST LICENSE