Provider Demographics
NPI:1275166894
Name:SHAH, AMAR JAYESH (PHARMD)
Entity Type:Individual
Prefix:
First Name:AMAR
Middle Name:JAYESH
Last Name:SHAH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 S WRIGHT ST
Mailing Address - Street 2:
Mailing Address - City:DELAVAN
Mailing Address - State:WI
Mailing Address - Zip Code:53115-2013
Mailing Address - Country:US
Mailing Address - Phone:262-728-3999
Mailing Address - Fax:
Practice Address - Street 1:445 S WRIGHT ST
Practice Address - Street 2:
Practice Address - City:DELAVAN
Practice Address - State:WI
Practice Address - Zip Code:53115-2013
Practice Address - Country:US
Practice Address - Phone:262-728-3999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-21
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI19655-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist