Provider Demographics
NPI:1356614580
Name:SHAH, PURVI H (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:PURVI
Middle Name:H
Last Name:SHAH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 GREENWAY SQ
Mailing Address - Street 2:APT K22
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-2682
Mailing Address - Country:US
Mailing Address - Phone:302-359-0586
Mailing Address - Fax:
Practice Address - Street 1:66 GREENWAY SQ
Practice Address - Street 2:APT K22
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-2682
Practice Address - Country:US
Practice Address - Phone:302-359-0586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-19
Last Update Date:2012-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0003851183500000X
NJ28RI03402700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist