Provider Demographics
NPI:1346591674
Name:SHAH, DARSHAN C
Entity Type:Individual
Prefix:
First Name:DARSHAN
Middle Name:C
Last Name:SHAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 ASH ST
Mailing Address - Street 2:APT # 4
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-2860
Mailing Address - Country:US
Mailing Address - Phone:845-782-9186
Mailing Address - Fax:
Practice Address - Street 1:475 NEW YORK 17M
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950
Practice Address - Country:US
Practice Address - Phone:845-783-3101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-26
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY057303183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist