Provider Demographics
NPI:1750673596
Name:SHAH, ANKUR A (RPH)
Entity Type:Individual
Prefix:MR
First Name:ANKUR
Middle Name:A
Last Name:SHAH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:MR
Other - First Name:ANKUR
Other - Middle Name:A
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BS PHARM
Mailing Address - Street 1:4863 OUTLOOK DR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-2335
Mailing Address - Country:US
Mailing Address - Phone:321-775-0911
Mailing Address - Fax:321-775-0912
Practice Address - Street 1:930 MALABAR RD SE STE 1
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-3252
Practice Address - Country:US
Practice Address - Phone:321-775-0911
Practice Address - Fax:321-775-0912
Is Sole Proprietor?:No
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS037426183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist