Provider Demographics
NPI:1588814875
Name:SHAH, NIRANJAN R (RPH,)
Entity Type:Individual
Prefix:MR
First Name:NIRANJAN
Middle Name:R
Last Name:SHAH
Suffix:
Gender:M
Credentials:RPH,
Other - Prefix:MR
Other - First Name:NIRU
Other - Middle Name:R
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH,
Mailing Address - Street 1:1 S CORPORATE DR
Mailing Address - Street 2:SUITE D- 2ND FLOOR
Mailing Address - City:RIVERDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07457-1718
Mailing Address - Country:US
Mailing Address - Phone:973-513-9036
Mailing Address - Fax:973-513-9037
Practice Address - Street 1:1 S CORPORATE DR
Practice Address - Street 2:SUITE D- 2ND FLOOR
Practice Address - City:RIVERDALE
Practice Address - State:NJ
Practice Address - Zip Code:07457-1718
Practice Address - Country:US
Practice Address - Phone:973-513-9036
Practice Address - Fax:973-513-9037
Is Sole Proprietor?:No
Enumeration Date:2008-09-24
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01463300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist