Provider Demographics
NPI:1598097453
Name:SHAH, SYED (RPH)
Entity Type:Individual
Prefix:
First Name:SYED
Middle Name:
Last Name:SHAH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:SYED
Other - Middle Name:MUBARIK
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:16506 78TH AVE
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11366-1225
Mailing Address - Country:US
Mailing Address - Phone:917-821-6143
Mailing Address - Fax:718-699-2858
Practice Address - Street 1:9431 59TH AVE
Practice Address - Street 2:FRANKLIN PHARMACY
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373
Practice Address - Country:US
Practice Address - Phone:718-592-7200
Practice Address - Fax:718-699-2858
Is Sole Proprietor?:No
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040460183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist