Provider Demographics
NPI:1144389305
Name:SHAH, NUTAN MOTICHAND (RPH)
Entity Type:Individual
Prefix:MR
First Name:NUTAN
Middle Name:MOTICHAND
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 1:36957 ASPEN DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48335-5487
Mailing Address - Country:US
Mailing Address - Phone:248-442-1477
Mailing Address - Fax:248-442-1477
Practice Address - Street 1:6002 N LAPEER RD
Practice Address - Street 2:
Practice Address - City:NORTH BRANCH
Practice Address - State:MI
Practice Address - Zip Code:48461-9730
Practice Address - Country:US
Practice Address - Phone:810-793-5006
Practice Address - Fax:810-793-5101
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302026181183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist