Provider Demographics
NPI:1720300148
Name:SHAH, RITA J (RPH)
Entity Type:Individual
Prefix:MRS
First Name:RITA
Middle Name:J
Last Name:SHAH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:99-1 ROUTE 25A
Mailing Address - Street 2:PO BOX 876
Mailing Address - City:SHOREHAM
Mailing Address - State:NY
Mailing Address - Zip Code:11786
Mailing Address - Country:US
Mailing Address - Phone:631-821-0707
Mailing Address - Fax:631-821-5963
Practice Address - Street 1:99-1 ROUTE 25A
Practice Address - Street 2:
Practice Address - City:SHOREHAM
Practice Address - State:NY
Practice Address - Zip Code:11786
Practice Address - Country:US
Practice Address - Phone:631-821-0707
Practice Address - Fax:631-821-5963
Is Sole Proprietor?:No
Enumeration Date:2010-02-26
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042495183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist