Provider Demographics
NPI:1346606100
Name:SHAH, PARTH ARUNKUMAR
Entity Type:Individual
Prefix:
First Name:PARTH
Middle Name:ARUNKUMAR
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 1:2443 RUBEL WAY APT F
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93455-8413
Mailing Address - Country:US
Mailing Address - Phone:781-439-0037
Mailing Address - Fax:
Practice Address - Street 1:2399 S BROADWAY
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-7832
Practice Address - Country:US
Practice Address - Phone:805-928-4633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-10
Last Update Date:2016-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA74239183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist