Provider Demographics
NPI:1831616515
Name:PEARL SHAH LLC
Entity type:Organization
Organization Name:PEARL SHAH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MGRM
Authorized Official - Prefix:
Authorized Official - First Name:AMIT
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:DHIMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-389-5900
Mailing Address - Street 1:6399 38TH AVE N STE A5
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-1651
Mailing Address - Country:US
Mailing Address - Phone:727-201-9500
Mailing Address - Fax:727-201-9501
Practice Address - Street 1:6399 38TH AVE N STE A5
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-1651
Practice Address - Country:US
Practice Address - Phone:727-201-9500
Practice Address - Fax:727-201-9501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH276593336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPH27659Medicaid