Provider Demographics
NPI:1356640122
Name:SHAH, VANDITA (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:VANDITA
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4821 LJ PKWY STE 60
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-4987
Mailing Address - Country:US
Mailing Address - Phone:717-503-2028
Mailing Address - Fax:281-524-7899
Practice Address - Street 1:4821 LJ PKWY STE 60
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-4987
Practice Address - Country:US
Practice Address - Phone:717-503-2028
Practice Address - Fax:281-524-7899
Is Sole Proprietor?:No
Enumeration Date:2011-03-19
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP444041183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist