Provider Demographics
NPI:1780795922
Name:SHAH, SAJID IJAZ (RPH)
Entity type:Individual
Prefix:
First Name:SAJID
Middle Name:IJAZ
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 1:369 WOODBURY RD
Mailing Address - Street 2:SAJID SHAH WOODBURY
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:11797
Mailing Address - Country:US
Mailing Address - Phone:516-367-3534
Mailing Address - Fax:
Practice Address - Street 1:1367 BROADWAY
Practice Address - Street 2:SAMS DRUGS BROOKLYN
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:11797
Practice Address - Country:US
Practice Address - Phone:718-453-6866
Practice Address - Fax:718-452-2686
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031983183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist