Provider Demographics
NPI:1962749176
Name:SHAH, KRISHNA (RPH)
Entity type:Individual
Prefix:
First Name:KRISHNA
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3202 132ND STREET, S.E.
Mailing Address - Street 2:MILL CREEK
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012
Mailing Address - Country:US
Mailing Address - Phone:773-677-4436
Mailing Address - Fax:
Practice Address - Street 1:3202 132ND ST SE
Practice Address - Street 2:MILL CREEK
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-5624
Practice Address - Country:US
Practice Address - Phone:773-677-4436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-08
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60302255183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist