Provider Demographics
NPI:1922306166
Name:SHAH, RAJESH SURESHCHANDRA
Entity Type:Individual
Prefix:MR
First Name:RAJESH
Middle Name:SURESHCHANDRA
Last Name:SHAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15221 JOHN J DELANEY DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-2742
Mailing Address - Country:US
Mailing Address - Phone:704-543-7865
Mailing Address - Fax:704-543-7865
Practice Address - Street 1:15221 JOHN J DELANEY DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-2742
Practice Address - Country:US
Practice Address - Phone:704-543-7865
Practice Address - Fax:704-543-7865
Is Sole Proprietor?:No
Enumeration Date:2011-03-12
Last Update Date:2011-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9744183500000X
SC7132183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist