Provider Demographics
NPI:1821647603
Name:SHAH, MANAN NILESHKUMAR (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:MANAN
Middle Name:NILESHKUMAR
Last Name:SHAH
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 WHITE BIRCH RD
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837-2041
Mailing Address - Country:US
Mailing Address - Phone:267-574-5842
Mailing Address - Fax:
Practice Address - Street 1:170 WHITE BIRCH RD
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-2041
Practice Address - Country:US
Practice Address - Phone:267-574-5842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY065960183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist