Provider Demographics
NPI:1477609493
Name:SHAH, BHARAT D (RPH)
Entity Type:Individual
Prefix:MR
First Name:BHARAT
Middle Name:D
Last Name:SHAH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15828 GLENARN DR.
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-1652
Mailing Address - Country:US
Mailing Address - Phone:813-968-4088
Mailing Address - Fax:
Practice Address - Street 1:15828 GLENARN DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-1652
Practice Address - Country:US
Practice Address - Phone:813-968-4088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS29605183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist