Provider Demographics
NPI:1710342266
Name:SHAH, RIZWAN S (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:RIZWAN
Middle Name:S
Last Name:SHAH
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 1:1367 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11221
Mailing Address - Country:US
Mailing Address - Phone:718-453-6866
Mailing Address - Fax:
Practice Address - Street 1:1367 BROADWAY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11221-3618
Practice Address - Country:US
Practice Address - Phone:718-453-6866
Practice Address - Fax:718-452-2686
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-29
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY061290183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist