Provider Demographics
NPI:1194984435
Name:TRIVEDI, SANJAYKUMAR PRAVINBHAI (RPH)
Entity type:Individual
Prefix:
First Name:SANJAYKUMAR
Middle Name:PRAVINBHAI
Last Name:TRIVEDI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:826 E TREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10460-4146
Mailing Address - Country:US
Mailing Address - Phone:718-294-7147
Mailing Address - Fax:718-294-7146
Practice Address - Street 1:826 E TREMONT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10460-4146
Practice Address - Country:US
Practice Address - Phone:718-294-7147
Practice Address - Fax:718-294-7146
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047910183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist