Provider Demographics
NPI:1174990840
Name:VIRADIA, VIRA
Entity type:Individual
Prefix:
First Name:VIRA
Middle Name:
Last Name:VIRADIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 N CUSTER RD
Mailing Address - Street 2:APT 2215
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013
Mailing Address - Country:US
Mailing Address - Phone:614-707-9737
Mailing Address - Fax:
Practice Address - Street 1:321 N PRESTON RD STE B
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-8881
Practice Address - Country:US
Practice Address - Phone:972-347-6331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-28
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX56209183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist