Healthcare Provider Details

I. General information

NPI: 1811246150
Provider Name (Legal Business Name): VISHAL ARYA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2012
Last Update Date: 08/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2518 AUSTIN AVE
CLOVIS CA
93611
US

IV. Provider business mailing address

2518 AUSTIN AVE
CLOVIS CA
93611
US

V. Phone/Fax

Practice location:
  • Phone: 559-776-9254
  • Fax:
Mailing address:
  • Phone: 559-776-9254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number65955
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: