Provider Demographics
NPI:1538723226
Name:THOMAS VAIDHYAN, JULEY
Entity type:Individual
Prefix:
First Name:JULEY
Middle Name:
Last Name:THOMAS VAIDHYAN
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 1:328 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:FILLMORE
Mailing Address - State:CA
Mailing Address - Zip Code:93015-1921
Mailing Address - Country:US
Mailing Address - Phone:805-524-0052
Mailing Address - Fax:805-525-2575
Practice Address - Street 1:328 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:FILLMORE
Practice Address - State:CA
Practice Address - Zip Code:93015-1921
Practice Address - Country:US
Practice Address - Phone:805-524-0052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-28
Last Update Date:2019-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA68003183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist