Provider Demographics
NPI:1669626537
Name:SHAH, KRUTI (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KRUTI
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
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:PO BOX 1159
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19899-1159
Mailing Address - Country:US
Mailing Address - Phone:302-651-9196
Mailing Address - Fax:
Practice Address - Street 1:501 N SHIPLEY ST
Practice Address - Street 2:UNIT 2
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19801-2252
Practice Address - Country:US
Practice Address - Phone:302-658-9196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0003812183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist