Provider Demographics
NPI:1568788412
Name:SHAH, HETAL N (PHARMD)
Entity Type:Individual
Prefix:
First Name:HETAL
Middle Name:N
Last Name:SHAH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 MERIDIAN WAY
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-5835
Mailing Address - Country:US
Mailing Address - Phone:215-295-5590
Mailing Address - Fax:
Practice Address - Street 1:657 HEACOCK RD
Practice Address - Street 2:
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-6338
Practice Address - Country:US
Practice Address - Phone:215-321-0105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-18
Last Update Date:2010-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP442122183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP442122OtherPHARMACIST LICENSE NUMBER