Provider Demographics
NPI:1740563105
Name:SHAH, NIRAV K (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NIRAV
Middle Name:K
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 1:2464 ROSWELL RD
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-4954
Mailing Address - Country:US
Mailing Address - Phone:678-560-4781
Mailing Address - Fax:678-560-4785
Practice Address - Street 1:2464 ROSWELL RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-4954
Practice Address - Country:US
Practice Address - Phone:678-560-4781
Practice Address - Fax:678-560-4785
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH021308183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist