Provider Demographics
NPI:1871854976
Name:SHAH, JAYASHRI J (PHARM B)
Entity Type:Individual
Prefix:MRS
First Name:JAYASHRI
Middle Name:J
Last Name:SHAH
Suffix:
Gender:F
Credentials:PHARM B
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 HAWTHORN DR
Mailing Address - Street 2:
Mailing Address - City:PLAINSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08536-1934
Mailing Address - Country:US
Mailing Address - Phone:609-275-1027
Mailing Address - Fax:
Practice Address - Street 1:775 ROUTE 1
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-4679
Practice Address - Country:US
Practice Address - Phone:732-819-8573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02304700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ9093907Medicaid