Provider Demographics
NPI:1114056108
Name:SHAH, ABHAYKUMAR SOBHAGCHAND (BS(PHARM))
Entity Type:Individual
Prefix:MR
First Name:ABHAYKUMAR
Middle Name:SOBHAGCHAND
Last Name:SHAH
Suffix:
Gender:M
Credentials:BS(PHARM)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5318 HIDDEN OAKS DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33811-4064
Mailing Address - Country:US
Mailing Address - Phone:863-709-8335
Mailing Address - Fax:863-709-8335
Practice Address - Street 1:6745 NORTH CURCH AVE
Practice Address - Street 2:
Practice Address - City:MULBERRY
Practice Address - State:FL
Practice Address - Zip Code:33860
Practice Address - Country:US
Practice Address - Phone:863-701-8049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS36495183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS36495OtherSTATE LICENSE
FL1000291OtherNCPDP
FLBW8524008OtherDEA