Provider Demographics
NPI:1124012703
Name:SHAH, BHAVESH H (RPH)
Entity Type:Individual
Prefix:MR
First Name:BHAVESH
Middle Name:H
Last Name:SHAH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:85 E INDIA ROW
Mailing Address - Street 2:APT #8H
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02110-3320
Mailing Address - Country:US
Mailing Address - Phone:617-331-3150
Mailing Address - Fax:617-638-6786
Practice Address - Street 1:88 E NEWTON ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2658
Practice Address - Country:US
Practice Address - Phone:617-638-6775
Practice Address - Fax:617-638-6786
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA255811835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy