Provider Demographics
NPI:1588724983
Name:LALKIYA, JAYSUKH MOHANBHAI (RPH)
Entity type:Individual
Prefix:MR
First Name:JAYSUKH
Middle Name:MOHANBHAI
Last Name:LALKIYA
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 1:67 E COUNTRY GATE PL
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850
Mailing Address - Country:US
Mailing Address - Phone:607-786-9461
Mailing Address - Fax:607-625-2428
Practice Address - Street 1:6845 STATE ROUTE 434
Practice Address - Street 2:
Practice Address - City:APALACHIN
Practice Address - State:NY
Practice Address - Zip Code:13732-3503
Practice Address - Country:US
Practice Address - Phone:607-625-2129
Practice Address - Fax:607-625-2428
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040537183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist