Provider Demographics
NPI:1528182151
Name:SHAH, BHUPENDRA S (RPH)
Entity Type:Individual
Prefix:MR
First Name:BHUPENDRA
Middle Name:S
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 1:6570 N STATE ROAD 7
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-3625
Mailing Address - Country:US
Mailing Address - Phone:954-422-5481
Mailing Address - Fax:954-422-5484
Practice Address - Street 1:8374 SHADOW WOOD BLVD
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-6738
Practice Address - Country:US
Practice Address - Phone:954-752-5460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS14988183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist