Provider Demographics
NPI:1518005115
Name:SHAH, SHAILESH B (MS, RPH)
Entity Type:Individual
Prefix:MR
First Name:SHAILESH
Middle Name:B
Last Name:SHAH
Suffix:
Gender:M
Credentials:MS, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 YALE CT
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-1519
Mailing Address - Country:US
Mailing Address - Phone:973-533-0269
Mailing Address - Fax:973-533-0369
Practice Address - Street 1:570 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07107-1346
Practice Address - Country:US
Practice Address - Phone:973-482-6753
Practice Address - Fax:973-482-0356
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26RI01963800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ26RI01963800OtherPHARMACIST LIC#