MEDICARE: TEJAS SHAH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	5302034770	MI

General Provider Information

NPI Number	:	1184395279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TEJAS SHAH

Provider Business Mailing Address
First Line	:	14039 W MCNICHOLS RD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48235-3929
Country	:	US
Telephone Number	:	313-861-9300
Fax Number	:

Provider Business Practice Location Address
First Line	:	14039 W MCNICHOLS RD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48235-3929
Country	:	US
Telephone Number	:	313-861-9300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2021
Last Update Date	:	09/28/2021

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Directions to “ TEJAS SHAH ” Practice Location

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