Provider Demographics
NPI:1710341318
Name:KAMBERI, SHPETIM (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SHPETIM
Middle Name:
Last Name:KAMBERI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:TIM
Other - Middle Name:
Other - Last Name:KAMBERI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:3710 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-3613
Mailing Address - Country:US
Mailing Address - Phone:203-371-1280
Mailing Address - Fax:203-372-5468
Practice Address - Street 1:3710 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-3613
Practice Address - Country:US
Practice Address - Phone:203-371-1280
Practice Address - Fax:203-372-5468
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-09
Last Update Date:2016-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT11280183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist