Provider Demographics
NPI:1730446881
Name:VYAS, BHUPENDRA S (RPH)
Entity type:Individual
Prefix:MR
First Name:BHUPENDRA
Middle Name:S
Last Name:VYAS
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 1:551 MORRIS AVE APT D
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-1055
Mailing Address - Country:US
Mailing Address - Phone:973-479-5100
Mailing Address - Fax:
Practice Address - Street 1:8001 N. LINCOLN AVE # 800
Practice Address - Street 2:C/O RPH ON THE GO SUITE 800
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077
Practice Address - Country:US
Practice Address - Phone:847-588-7170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-13
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI021364001835G0303X
NY029010-11835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric