Provider Demographics
NPI:1710166699
Name:SHAH, SAMIR K (RPH)
Entity Type:Individual
Prefix:MR
First Name:SAMIR
Middle Name:K
Last Name:SHAH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 GRAND VIEW TER
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10918-8201
Mailing Address - Country:US
Mailing Address - Phone:845-469-4618
Mailing Address - Fax:
Practice Address - Street 1:187 MILL ST
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:NY
Practice Address - Zip Code:12754-2000
Practice Address - Country:US
Practice Address - Phone:845-292-3430
Practice Address - Fax:845-292-3437
Is Sole Proprietor?:No
Enumeration Date:2007-10-29
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048917183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist