Provider Demographics
NPI:1508091042
Name:SHAH, SANGITA A (RPH)
Entity Type:Individual
Prefix:
First Name:SANGITA
Middle Name:A
Last Name:SHAH
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 1:5225 CANYON CREST DR STE 8
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-6320
Mailing Address - Country:US
Mailing Address - Phone:951-686-2203
Mailing Address - Fax:951-686-4980
Practice Address - Street 1:5225 CANYON CREST DR STE 8
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-6320
Practice Address - Country:US
Practice Address - Phone:951-686-2203
Practice Address - Fax:951-686-4980
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-28
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42359183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist