Provider Demographics
NPI:1104484377
Name:KALE, VIJAY (PHD, RPH)
Entity type:Individual
Prefix:
First Name:VIJAY
Middle Name:
Last Name:KALE
Suffix:
Gender:M
Credentials:PHD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10920 S RIVER FRONT PKWY
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-3538
Mailing Address - Country:US
Mailing Address - Phone:801-878-1078
Mailing Address - Fax:
Practice Address - Street 1:10920 S RIVER FRONT PKWY
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-3538
Practice Address - Country:US
Practice Address - Phone:801-878-1078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8612317-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist