Provider Demographics
NPI:1720260318
Name:SHAH, ANKUR (RPH)
Entity Type:Individual
Prefix:MR
First Name:ANKUR
Middle Name:
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 1:300 PARK PL
Mailing Address - Street 2:
Mailing Address - City:SECAUCUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07094-3653
Mailing Address - Country:US
Mailing Address - Phone:201-974-0556
Mailing Address - Fax:201-974-0224
Practice Address - Street 1:300 PARK PL
Practice Address - Street 2:
Practice Address - City:SECAUCUS
Practice Address - State:NJ
Practice Address - Zip Code:07094-3653
Practice Address - Country:US
Practice Address - Phone:201-974-0556
Practice Address - Fax:201-974-0224
Is Sole Proprietor?:No
Enumeration Date:2007-12-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02932800183500000X
PARP439225183500000X
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist