Provider Demographics
NPI:1962015206
Name:SHELAT, VIJAY (RPH)
Entity Type:Individual
Prefix:
First Name:VIJAY
Middle Name:
Last Name:SHELAT
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25405 HANCOCK AVE
Mailing Address - Street 2:SUITE #100
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562
Mailing Address - Country:US
Mailing Address - Phone:951-304-2038
Mailing Address - Fax:951-304-2068
Practice Address - Street 1:25405 HANCOCK AVE
Practice Address - Street 2:SUITE #100
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562
Practice Address - Country:US
Practice Address - Phone:951-304-2038
Practice Address - Fax:951-304-2068
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA451113336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy