Healthcare Provider Details

I. General information

NPI: 1154921211
Provider Name (Legal Business Name): VINAY SONI PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2020
Last Update Date: 10/28/2020
Certification Date: 10/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4224 N PROSPECT DR
DECATUR IL
62526-6100
US

IV. Provider business mailing address

4224 N PROSPECT DR
DECATUR IL
62526-6100
US

V. Phone/Fax

Practice location:
  • Phone: 217-875-0190
  • Fax: 217-875-0186
Mailing address:
  • Phone: 217-875-0190
  • Fax: 217-875-0186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number051297940
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: