Provider Demographics
NPI:1003364936
Name:SHABANI, JUXHIN (PHARMD)
Entity Type:Individual
Prefix:
First Name:JUXHIN
Middle Name:
Last Name:SHABANI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 W LINCOLN TRAIL BLVD
Mailing Address - Street 2:
Mailing Address - City:RADCLIFF
Mailing Address - State:KY
Mailing Address - Zip Code:40160-2671
Mailing Address - Country:US
Mailing Address - Phone:270-341-7400
Mailing Address - Fax:270-351-7474
Practice Address - Street 1:800 W LINCOLN TRAIL BLVD
Practice Address - Street 2:
Practice Address - City:RADCLIFF
Practice Address - State:KY
Practice Address - Zip Code:40160-2671
Practice Address - Country:US
Practice Address - Phone:270-341-7400
Practice Address - Fax:270-351-7474
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-20
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY018612183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist