Provider Demographics
NPI:1922441682
Name:KIRTI Z SHAH INC
Entity Type:Organization
Organization Name:KIRTI Z SHAH INC
Other - Org Name:DESERT MEDICAL PHARMACY #2
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / PIC
Authorized Official - Prefix:
Authorized Official - First Name:KIRTI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:PD
Authorized Official - Phone:760-592-4442
Mailing Address - Street 1:401 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-3006
Mailing Address - Country:US
Mailing Address - Phone:760-592-4442
Mailing Address - Fax:760-592-4652
Practice Address - Street 1:401 W MAIN ST
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-3006
Practice Address - Country:US
Practice Address - Phone:760-592-4442
Practice Address - Fax:760-592-4652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-12
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
CAPHY514463336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2140504OtherPK