Provider Demographics
NPI:1831600915
Name:SHETH, PRATIK (PHARMD)
Entity type:Individual
Prefix:
First Name:PRATIK
Middle Name:
Last Name:SHETH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:192 FAIRFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06604-4205
Mailing Address - Country:US
Mailing Address - Phone:203-330-9191
Mailing Address - Fax:203-330-9193
Practice Address - Street 1:192 FAIRFIELD AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06604-4205
Practice Address - Country:US
Practice Address - Phone:203-330-9191
Practice Address - Fax:203-330-9193
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-17
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP7676183500000X
CTPCT.0013883183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist