Provider Demographics
NPI:1578999363
Name:SHUKLA, DHARA MAYANK (PHARMD)
Entity Type:Individual
Prefix:
First Name:DHARA
Middle Name:MAYANK
Last Name:SHUKLA
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 1:436 INNES RD
Mailing Address - Street 2:
Mailing Address - City:WOOD RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07075-1254
Mailing Address - Country:US
Mailing Address - Phone:201-982-8043
Mailing Address - Fax:
Practice Address - Street 1:1819 MARLTON PIKE W
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-3206
Practice Address - Country:US
Practice Address - Phone:856-662-3685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-24
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03594000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist