Provider Demographics
NPI:1497407712
Name:SHAH, BHAVIN D
Entity Type:Individual
Prefix:
First Name:BHAVIN
Middle Name:D
Last Name:SHAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4910 34TH ST S
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33711-4512
Mailing Address - Country:US
Mailing Address - Phone:727-867-4900
Mailing Address - Fax:855-659-5991
Practice Address - Street 1:4910 34TH ST S
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33711-4512
Practice Address - Country:US
Practice Address - Phone:727-867-4900
Practice Address - Fax:855-659-5991
Is Sole Proprietor?:No
Enumeration Date:2022-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS45602183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist