Provider Demographics
NPI:1609592401
Name:SHAH, MANISH (RPH, MS)
Entity Type:Individual
Prefix:
First Name:MANISH
Middle Name:
Last Name:SHAH
Suffix:
Gender:M
Credentials:RPH, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 LOCKWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-6054
Mailing Address - Country:US
Mailing Address - Phone:407-366-1717
Mailing Address - Fax:407-366-1361
Practice Address - Street 1:1030 LOCKWOOD BLVD
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-6054
Practice Address - Country:US
Practice Address - Phone:407-366-1717
Practice Address - Fax:407-366-1361
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS39388183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist