Provider Demographics
NPI:1336624725
Name:SHAH, KAUSHIK KIRTIKUMAR (RPH)
Entity Type:Individual
Prefix:DR
First Name:KAUSHIK
Middle Name:KIRTIKUMAR
Last Name:SHAH
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 1:2711 SW 58TH AVE
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79118-1329
Mailing Address - Country:US
Mailing Address - Phone:806-513-6505
Mailing Address - Fax:806-513-6504
Practice Address - Street 1:2711 SW 58TH AVE
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79118-1329
Practice Address - Country:US
Practice Address - Phone:806-513-6505
Practice Address - Fax:806-513-6504
Is Sole Proprietor?:No
Enumeration Date:2018-10-01
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX60125183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist