Provider Demographics
NPI:1881938280
Name:RYALI, VIJAYA DURGA (RPH)
Entity type:Individual
Prefix:MRS
First Name:VIJAYA
Middle Name:DURGA
Last Name:RYALI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MISS
Other - First Name:VIJAYA
Other - Middle Name:DURGA
Other - Last Name:VEERAMACHANENI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:PO BOX 496
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-0496
Mailing Address - Country:US
Mailing Address - Phone:248-470-4286
Mailing Address - Fax:
Practice Address - Street 1:515 SAW MILL RD
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-4000
Practice Address - Country:US
Practice Address - Phone:248-470-4286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0011508183500000X
MI5302033458183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist