Provider Demographics
NPI:1568140291
Name:SELVARAJ, SHAILENDRA VIKNESH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SHAILENDRA
Middle Name:VIKNESH
Last Name:SELVARAJ
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:RAJ
Other - Middle Name:VIKNESH
Other - Last Name:SELVARAJ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:3537 BROADWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-2501
Mailing Address - Country:US
Mailing Address - Phone:816-561-1933
Mailing Address - Fax:
Practice Address - Street 1:3537 BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-2501
Practice Address - Country:US
Practice Address - Phone:816-561-1933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023025078183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist