MEDICARE: TEJAL 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	64176	TX
2	183500000X	Pharmacist	PS55691	FL

General Provider Information

NPI Number	:	1396275939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TEJAL SHAH

Provider Business Mailing Address
First Line	:	19152 DOVE CREEK DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-3073
Country	:	US
Telephone Number	:	813-507-7211
Fax Number	:

Provider Business Practice Location Address
First Line	:	408 N ALLEN DR STE 100
Second Line	:
City	:	ALLEN
State	:	TX
Zip	:	75013-2500
Country	:	US
Telephone Number	:	469-257-4200
Fax Number	:

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

Provider Enumeration Date	:	06/15/2017
Last Update Date	:	10/29/2021

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Directions to “ TEJAL SHAH ” Practice Location

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