Provider Demographics
NPI:1477861938
Name:SHAH, KUSHAN G (RPH)
Entity Type:Individual
Prefix:DR
First Name:KUSHAN
Middle Name:G
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 1:164 PARSIPPANY RD
Mailing Address - Street 2:
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054-4708
Mailing Address - Country:US
Mailing Address - Phone:973-887-9444
Mailing Address - Fax:
Practice Address - Street 1:164 PARSIPPANY RD
Practice Address - Street 2:
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-4708
Practice Address - Country:US
Practice Address - Phone:973-887-9444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-18
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03371000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist