Provider Demographics
NPI:1881193613
Name:SHAH, SEJAL DHAVALKUMAR (PHARMACIST(BPHARM))
Entity Type:Individual
Prefix:MRS
First Name:SEJAL
Middle Name:DHAVALKUMAR
Last Name:SHAH
Suffix:
Gender:F
Credentials:PHARMACIST(BPHARM)
Other - Prefix:MISS
Other - First Name:SEJAL
Other - Middle Name:BHARATKUMAR
Other - Last Name:JARIWALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4 BRANCH WAY
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:NY
Mailing Address - Zip Code:14086-3427
Mailing Address - Country:US
Mailing Address - Phone:646-467-0811
Mailing Address - Fax:
Practice Address - Street 1:34 BENWOOD AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-1761
Practice Address - Country:US
Practice Address - Phone:716-332-6811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-07
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302036558183500000X
CTPCT.0011582183500000X
NY1059112-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist