Provider Demographics
NPI:1912084674
Name:DAWOODBHAI, SHABBIR S (RPH)
Entity Type:Individual
Prefix:MR
First Name:SHABBIR
Middle Name:S
Last Name:DAWOODBHAI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6927 COLLINGWOOD LN APT 7
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-2123
Mailing Address - Country:US
Mailing Address - Phone:651-739-9519
Mailing Address - Fax:
Practice Address - Street 1:870 GRAND AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-3291
Practice Address - Country:US
Practice Address - Phone:651-225-2883
Practice Address - Fax:651-225-2890
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN116648-0183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist