Provider Demographics
NPI:1720300429
Name:SHAH, DHANESH BHOGILAL (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:DHANESH
Middle Name:BHOGILAL
Last Name:SHAH
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103,WEST 188 STREET
Mailing Address - Street 2:GAYATRI PHARMACY
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468
Mailing Address - Country:US
Mailing Address - Phone:718-220-4253
Mailing Address - Fax:718-584-6824
Practice Address - Street 1:103 WEST 188 STREET
Practice Address - Street 2:GAYATRI PHARMACY
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468
Practice Address - Country:US
Practice Address - Phone:718-220-4253
Practice Address - Fax:718-584-6824
Is Sole Proprietor?:No
Enumeration Date:2010-02-22
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY33688183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist