Provider Demographics
NPI:1013295617
Name:SHAH, PRATIK D (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:PRATIK
Middle Name:D
Last Name:SHAH
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 TYSKA AVE
Mailing Address - Street 2:
Mailing Address - City:SAYREVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08872-1778
Mailing Address - Country:US
Mailing Address - Phone:732-824-1434
Mailing Address - Fax:
Practice Address - Street 1:231 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:SOUTH RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08882-1124
Practice Address - Country:US
Practice Address - Phone:732-254-7777
Practice Address - Fax:732-824-1124
Is Sole Proprietor?:No
Enumeration Date:2011-07-30
Last Update Date:2011-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03428100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist