Provider Demographics
NPI:1558559781
Name:SHAH, RUPESH CHANDRAVADAN (RPH)
Entity Type:Individual
Prefix:MR
First Name:RUPESH
Middle Name:CHANDRAVADAN
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 1:96 ROBIN DR
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-1160
Mailing Address - Country:US
Mailing Address - Phone:609-689-1709
Mailing Address - Fax:
Practice Address - Street 1:96 ROBIN DR
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-1160
Practice Address - Country:US
Practice Address - Phone:609-689-1709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-12
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRI02494000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist