Provider Demographics
NPI:1396035150
Name:TRIVEDI, SHRIJA MUKUNDBHAI (RPH)
Entity Type:Individual
Prefix:MS
First Name:SHRIJA
Middle Name:MUKUNDBHAI
Last Name:TRIVEDI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 WHITE TAIL RUN
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-7238
Mailing Address - Country:US
Mailing Address - Phone:270-605-0738
Mailing Address - Fax:
Practice Address - Street 1:1320 CUMBERLAND FALLS HWY
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-2719
Practice Address - Country:US
Practice Address - Phone:606-528-8270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-13
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY013991183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist