Provider Demographics
NPI:1508171638
Name:SHASTRI, RAJSHEKHAR H (RPH)
Entity Type:Individual
Prefix:MR
First Name:RAJSHEKHAR
Middle Name:H
Last Name:SHASTRI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:RAJ
Other - Middle Name:H
Other - Last Name:SHASTRI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:25100 HARPER AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-2207
Mailing Address - Country:US
Mailing Address - Phone:586-445-8181
Mailing Address - Fax:
Practice Address - Street 1:25100 HARPER AVE
Practice Address - Street 2:RITEAID 4500
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-2207
Practice Address - Country:US
Practice Address - Phone:586-445-8181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302031151183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist