Provider Demographics
NPI:1972133213
Name:SHETA, ANIL (RPH)
Entity Type:Individual
Prefix:
First Name:ANIL
Middle Name:
Last Name:SHETA
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 1:1037 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48226-1905
Mailing Address - Country:US
Mailing Address - Phone:313-963-1007
Mailing Address - Fax:313-963-1197
Practice Address - Street 1:1037 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48226-1905
Practice Address - Country:US
Practice Address - Phone:313-963-1007
Practice Address - Fax:313-963-1197
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-24
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5315126511183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist