Healthcare Provider Details

I. General information

NPI: 1104913490
Provider Name (Legal Business Name): NIRALI VINESH SONI PHARM D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 08/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20100 N 51ST AVE SUITE #F640
GLENDALE AZ
85308-5125
US

IV. Provider business mailing address

5420 W MURIEL DR
GLENDALE AZ
85308-5380
US

V. Phone/Fax

Practice location:
  • Phone: 623-521-5867
  • Fax: 602-441-3934
Mailing address:
  • Phone: 623-521-5867
  • Fax: 602-441-3934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11205
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number11205
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: