Provider Demographics
NPI:1568607976
Name:SHAH, RAJ B (MS)
Entity Type:Individual
Prefix:MR
First Name:RAJ
Middle Name:B
Last Name:SHAH
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 SIGOURNEY ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-5041
Mailing Address - Country:US
Mailing Address - Phone:860-424-5864
Mailing Address - Fax:860-424-4822
Practice Address - Street 1:25 SIGOURNEY ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-5041
Practice Address - Country:US
Practice Address - Phone:860-424-5864
Practice Address - Fax:860-424-4822
Is Sole Proprietor?:No
Enumeration Date:2008-12-15
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician