Provider Demographics
NPI:1396026878
Name:SHAH, RUSHABH R (PHARMD/ MBA)
Entity Type:Individual
Prefix:
First Name:RUSHABH
Middle Name:R
Last Name:SHAH
Suffix:
Gender:M
Credentials:PHARMD/ MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 FARMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06156-0001
Mailing Address - Country:US
Mailing Address - Phone:714-972-3410
Mailing Address - Fax:
Practice Address - Street 1:1500 PURDUE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025
Practice Address - Country:US
Practice Address - Phone:714-972-3410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-29
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.295298183500000X
CA67306183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist