Provider Demographics
NPI:1376149872
Name:SHAH, RAHULKUMAR V
Entity Type:Individual
Prefix:
First Name:RAHULKUMAR
Middle Name:V
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 1:3718 GREEN RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:FURLONG
Mailing Address - State:PA
Mailing Address - Zip Code:18925-1199
Mailing Address - Country:US
Mailing Address - Phone:267-879-4860
Mailing Address - Fax:866-357-8607
Practice Address - Street 1:172 N PINE ST
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-2141
Practice Address - Country:US
Practice Address - Phone:215-752-1100
Practice Address - Fax:866-357-8607
Is Sole Proprietor?:No
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP040589R183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist