Provider Demographics
NPI:1720362403
Name:SHAH, RADHIKA H (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:RADHIKA
Middle Name:H
Last Name:SHAH
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3344 TALBERT CIR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-5078
Mailing Address - Country:US
Mailing Address - Phone:317-413-7439
Mailing Address - Fax:
Practice Address - Street 1:4010 E 13 MILE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-1729
Practice Address - Country:US
Practice Address - Phone:586-575-9346
Practice Address - Fax:586-575-9812
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-29
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302036597183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist