Provider Demographics
NPI:1083161764
Name:SHAH, NIKITABEN JAGJIVANDAS (PHARMD)
Entity Type:Individual
Prefix:
First Name:NIKITABEN
Middle Name:JAGJIVANDAS
Last Name:SHAH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 MIDDLE TPKE W
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-3834
Mailing Address - Country:US
Mailing Address - Phone:860-205-4849
Mailing Address - Fax:
Practice Address - Street 1:241 MIDDLE TPKE W
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-3834
Practice Address - Country:US
Practice Address - Phone:860-533-1156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-09
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT. 0013674183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist