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General NPI Number Information
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NPI Number | 1194046060
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Entity Type | Individual
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Provider Name | VIJAYA KUMAR MANOHARAN RPH
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Gender | Male
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Dates
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Enumeration Date | 06/15/2010
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Last Update Date | 01/18/2023
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Provider Practice Location Address
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Address Line | 16 ROUTE 59
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City | NYACK
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State | NY
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Zip | 10960-2913
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Country | US
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Telephone | 845-358-1589
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Fax | 453-532-6738
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Provider Business Mailing Address
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Address Line | 16 ROUTE 59
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City | NYACK
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State | NY
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Zip | 10960-2972
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Country | US
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Telephone | 845-358-1589
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Fax | 845-353-2673
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 28RI03231800
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 057536
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License Number State | NY
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