Provider Demographics
NPI:1821123449
Name:SHAH, HARESH (RPH)
Entity Type:Individual
Prefix:
First Name:HARESH
Middle Name:
Last Name:SHAH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 NAGLE AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10040-1401
Mailing Address - Country:US
Mailing Address - Phone:212-942-5050
Mailing Address - Fax:212-942-5856
Practice Address - Street 1:102 NAGLE AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10040-1401
Practice Address - Country:US
Practice Address - Phone:212-942-5050
Practice Address - Fax:212-942-5856
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRI 27232183500000X
NY050694183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist