Provider Demographics
NPI:1124300314
Name:SHUKLA, NIRAV SUBHASHCHANDRA (RPH)
Entity type:Individual
Prefix:MR
First Name:NIRAV
Middle Name:SUBHASHCHANDRA
Last Name:SHUKLA
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 1:4201 JEWETTA AVE
Mailing Address - Street 2:APT G8
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-5473
Mailing Address - Country:US
Mailing Address - Phone:661-616-8560
Mailing Address - Fax:
Practice Address - Street 1:3301 PANAMA LANE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93313
Practice Address - Country:US
Practice Address - Phone:661-616-8560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63575183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist