Healthcare Provider Details

I. General information

NPI: 1063028751
Provider Name (Legal Business Name): VIDYA PHARMA INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2020
Last Update Date: 09/18/2020
Certification Date: 09/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 NORTH MAIN ST
LONE PINE CA
93545
US

IV. Provider business mailing address

25172 HUSTON ST
STEVENSON RANCH CA
91381-1672
US

V. Phone/Fax

Practice location:
  • Phone: 973-572-9954
  • Fax:
Mailing address:
  • Phone: 973-572-9954
  • Fax: 661-250-3806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MAHESHKUMAR KANERIA
Title or Position: CEO
Credential:
Phone: 973-572-9954