Provider Demographics
NPI:1972864916
Name:SHAH, AIDA (RPH)
Entity Type:Individual
Prefix:
First Name:AIDA
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 PUTNAM RD
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-7547
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10 TRIANGLE PLZ
Practice Address - Street 2:PATHMARK PHARMACY
Practice Address - City:RAMSEY
Practice Address - State:NJ
Practice Address - Zip Code:07446-1253
Practice Address - Country:US
Practice Address - Phone:201-934-7710
Practice Address - Fax:201-934-8251
Is Sole Proprietor?:No
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03074400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist