Provider Demographics
NPI:1700875424
Name:HASENDRA SHAH
Entity Type:Organization
Organization Name:HASENDRA SHAH
Other - Org Name:DELL'S LOS ALTOS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HASENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-597-2160
Mailing Address - Street 1:1777 N BELLFLOWER BLVD
Mailing Address - Street 2:#113
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815
Mailing Address - Country:US
Mailing Address - Phone:562-597-2160
Mailing Address - Fax:562-597-0648
Practice Address - Street 1:1777 N BELLFLOWER BLVD
Practice Address - Street 2:#113
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-4013
Practice Address - Country:US
Practice Address - Phone:562-597-2160
Practice Address - Fax:562-597-0648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-14
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY40629183500000X, 3336C0003X
CARPH32826183500000X
CAPHY406290332B00000X
CA0888600001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA406290Medicaid
CA0593500OtherNCPDP
CA0593500OtherNCPDP