Provider Demographics
NPI:1316227382
Name:JANARDHAN, VIJAY (RPH)
Entity type:Individual
Prefix:MRS
First Name:VIJAY
Middle Name:
Last Name:JANARDHAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3420 BRENTWOOD CT
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-1758
Mailing Address - Country:US
Mailing Address - Phone:734-663-1362
Mailing Address - Fax:
Practice Address - Street 1:2980 PACKARD ST
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-1881
Practice Address - Country:US
Practice Address - Phone:734-971-1013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-23
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302034380183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist