Provider Demographics
NPI:1457659799
Name:SHUKLA, ANUJ P (MS)
Entity Type:Individual
Prefix:
First Name:ANUJ
Middle Name:P
Last Name:SHUKLA
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3012 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-4118
Mailing Address - Country:US
Mailing Address - Phone:252-752-8500
Mailing Address - Fax:252-752-9198
Practice Address - Street 1:3012 E 10TH ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-4118
Practice Address - Country:US
Practice Address - Phone:252-752-8500
Practice Address - Fax:252-752-9198
Is Sole Proprietor?:No
Enumeration Date:2011-03-10
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18099183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist