Provider Demographics
NPI:1932625167
Name:SHAH, VIRAL PANKAJ (PHARMD)
Entity Type:Individual
Prefix:
First Name:VIRAL
Middle Name:PANKAJ
Last Name:SHAH
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 1:5315 AVION PARK DR STE 120
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-1461
Mailing Address - Country:US
Mailing Address - Phone:727-209-5722
Mailing Address - Fax:727-201-8923
Practice Address - Street 1:2708 W WATERS AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-1837
Practice Address - Country:US
Practice Address - Phone:813-932-6337
Practice Address - Fax:813-932-7455
Is Sole Proprietor?:No
Enumeration Date:2017-08-18
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS38128183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist