MEDICARE: PAYAL 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	S018169	AZ

General Provider Information

NPI Number	:	1265728976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAYAL SHAH

Provider Business Mailing Address
First Line	:	4515 E THOMAS RD
Second Line	:	T-0950
City	:	PHOENIX
State	:	AZ
Zip	:	85018-7614
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4515 E THOMAS RD
Second Line	:	T-0950
City	:	PHOENIX
State	:	AZ
Zip	:	85018-7614
Country	:	US
Telephone Number	:	602-840-9787
Fax Number	:	602-840-9787

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

Provider Enumeration Date	:	06/21/2011
Last Update Date	:	06/21/2011

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Directions to “ PAYAL SHAH ” Practice Location

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