Provider Demographics
NPI:1518333178
Name:SHAH, KIRTI MUKESHKUMAR (RPH)
Entity Type:Individual
Prefix:
First Name:KIRTI
Middle Name:MUKESHKUMAR
Last Name:SHAH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11724 E 28TH PL
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85367-3603
Mailing Address - Country:US
Mailing Address - Phone:617-971-6906
Mailing Address - Fax:
Practice Address - Street 1:1555 S AVENUE B
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-4324
Practice Address - Country:US
Practice Address - Phone:928-519-0208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-18
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS021497183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist