Provider Demographics
NPI:1659799534
Name:SHAH, JITESH
Entity Type:Individual
Prefix:
First Name:JITESH
Middle Name:
Last Name:SHAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1265 E UNIVERSITY DR
Mailing Address - Street 2:APT 2039
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-8426
Mailing Address - Country:US
Mailing Address - Phone:480-751-9342
Mailing Address - Fax:
Practice Address - Street 1:18460 N 7TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-1108
Practice Address - Country:US
Practice Address - Phone:602-993-5781
Practice Address - Fax:602-993-1291
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-28
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS018496183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist