Provider Demographics
NPI:1154921211
Name:SONI, VINAY (PHARMD)
Entity type:Individual
Prefix:
First Name:VINAY
Middle Name:
Last Name:SONI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4224 N PROSPECT DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-6100
Mailing Address - Country:US
Mailing Address - Phone:217-875-0190
Mailing Address - Fax:217-875-0186
Practice Address - Street 1:4224 N PROSPECT DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-6100
Practice Address - Country:US
Practice Address - Phone:217-875-0190
Practice Address - Fax:217-875-0186
Is Sole Proprietor?:No
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0512979401835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist