Provider Demographics
NPI:1093029647
Name:VASA, SHIMUL (RPH)
Entity Type:Individual
Prefix:
First Name:SHIMUL
Middle Name:
Last Name:VASA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 LEAHY MILL CT
Mailing Address - Street 2:
Mailing Address - City:WEDDINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28104-9745
Mailing Address - Country:US
Mailing Address - Phone:704-564-7213
Mailing Address - Fax:704-998-2370
Practice Address - Street 1:318 LEAHY MILL CT
Practice Address - Street 2:
Practice Address - City:WEDDINGTON
Practice Address - State:NC
Practice Address - Zip Code:28104-9745
Practice Address - Country:US
Practice Address - Phone:704-564-7213
Practice Address - Fax:704-998-2370
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-05
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12865183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist