Provider Demographics
NPI:1629346002
Name:PARIKH, SHIVAM A (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SHIVAM
Middle Name:A
Last Name:PARIKH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 S HOLLY AVE
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-6707
Mailing Address - Country:US
Mailing Address - Phone:609-992-2655
Mailing Address - Fax:
Practice Address - Street 1:855 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PLEASANTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08232-1441
Practice Address - Country:US
Practice Address - Phone:609-407-6562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03474100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist