Provider Demographics
NPI:1841396439
Name:SHAH, HINA A (RPH)
Entity Type:Individual
Prefix:MRS
First Name:HINA
Middle Name:A
Last Name:SHAH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2630 US HIGHWAY 92 E
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33801-2654
Mailing Address - Country:US
Mailing Address - Phone:863-665-5553
Mailing Address - Fax:863-665-5311
Practice Address - Street 1:2630 US HIGHWAY 92 E
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-2654
Practice Address - Country:US
Practice Address - Phone:863-665-5553
Practice Address - Fax:863-665-5311
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS36119183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1088144OtherNABP
FLPS36119OtherSTATE LICENSE
FLPS36119OtherSTATE LICENSE
FLPS36119OtherSTATE LICENSE