Provider Demographics
NPI:1740829035
Name:SHOJAAT, SHABNAM
Entity type:Individual
Prefix:
First Name:SHABNAM
Middle Name:
Last Name:SHOJAAT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 COGGINS DR APT B214
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-4571
Mailing Address - Country:US
Mailing Address - Phone:240-461-8414
Mailing Address - Fax:
Practice Address - Street 1:201 COGGINS DR APT B214
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-4571
Practice Address - Country:US
Practice Address - Phone:240-461-8414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-03
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04074000333600000X
CA85935183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No333600000XSuppliersPharmacy