Provider Demographics
NPI:1518235712
Name:SHAH, PRINA (PHARMD)
Entity Type:Individual
Prefix:
First Name:PRINA
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5295 N TRAVIS ST
Mailing Address - Street 2:APT 2306
Mailing Address - City:KNOLLWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:75092-4095
Mailing Address - Country:US
Mailing Address - Phone:515-554-4838
Mailing Address - Fax:
Practice Address - Street 1:5016 S US HIGHWAY 75
Practice Address - Street 2:TEXOMA MEDICAL CENTER
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-4584
Practice Address - Country:US
Practice Address - Phone:903-416-2066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-02
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX49647183500000X
IL051292682183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist