Provider Demographics
NPI:1669690806
Name:SHAH, VISHRUT G (RPH)
Entity type:Individual
Prefix:MR
First Name:VISHRUT
Middle Name:G
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 1:376 NORTHLAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-5261
Mailing Address - Country:US
Mailing Address - Phone:407-830-8820
Mailing Address - Fax:
Practice Address - Street 1:376 NORTHLAKE BLVD
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-5261
Practice Address - Country:US
Practice Address - Phone:407-830-8820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRI02686400183500000X
FLPS35236183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist