Provider Demographics
NPI:1154699262
Name:VAGDIYA, NARESH NAGJIBHAI
Entity type:Individual
Prefix:
First Name:NARESH
Middle Name:NAGJIBHAI
Last Name:VAGDIYA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 OAK TIMBER DR
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-6059
Mailing Address - Country:US
Mailing Address - Phone:817-283-9352
Mailing Address - Fax:
Practice Address - Street 1:602 AVENUE Q
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79401-2614
Practice Address - Country:US
Practice Address - Phone:806-747-3834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-02
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03470500183500000X
TX50917183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist