Provider Demographics
NPI:1053689919
Name:SHAH, DENISH B (RPH)
Entity Type:Individual
Prefix:
First Name:DENISH
Middle Name:B
Last Name:SHAH
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 1:1 COLONIAL CT
Mailing Address - Street 2:
Mailing Address - City:MONROE TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-5131
Mailing Address - Country:US
Mailing Address - Phone:973-460-1365
Mailing Address - Fax:
Practice Address - Street 1:1618 N OLDEN AVENUE EXT
Practice Address - Street 2:
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08638-3206
Practice Address - Country:US
Practice Address - Phone:609-588-3830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-07
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056371-1183500000X
NJ28RI02832800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist