Provider Demographics
NPI:1932581287
Name:VYAS, JAGRUTKUMAR KIRANKUMAR (PHARMD)
Entity Type:Individual
Prefix:
First Name:JAGRUTKUMAR
Middle Name:KIRANKUMAR
Last Name:VYAS
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 1:13733 N US HIGHWAY 441
Mailing Address - Street 2:
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159-8981
Mailing Address - Country:US
Mailing Address - Phone:352-391-5533
Mailing Address - Fax:
Practice Address - Street 1:13733 N US HIGHWAY 441
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-8981
Practice Address - Country:US
Practice Address - Phone:352-391-5533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-23
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS52089183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist