Provider Demographics
NPI:1518561323
Name:SHAH, KEYURKUMAR UPENDRAKUMAR (RPH)
Entity Type:Individual
Prefix:MR
First Name:KEYURKUMAR
Middle Name:UPENDRAKUMAR
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 1:19415 TERRA STONE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78255-2345
Mailing Address - Country:US
Mailing Address - Phone:830-285-2682
Mailing Address - Fax:
Practice Address - Street 1:3302 SE MILITARY DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78223-3734
Practice Address - Country:US
Practice Address - Phone:210-337-4434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX42848183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist