Provider Demographics
NPI:1962833467
Name:SHAH, MITEN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MITEN
Middle Name:
Last Name:SHAH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29928 MULEDEER LN.
Mailing Address - Street 2:
Mailing Address - City:CASTAIC
Mailing Address - State:CA
Mailing Address - Zip Code:91384
Mailing Address - Country:US
Mailing Address - Phone:661-294-1257
Mailing Address - Fax:
Practice Address - Street 1:29928 MULEDEER LN.
Practice Address - Street 2:
Practice Address - City:CASTAIC
Practice Address - State:CA
Practice Address - Zip Code:91384
Practice Address - Country:US
Practice Address - Phone:661-294-1257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-09
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA68966183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist