MEDICARE: PREMNATH V SHETTY RPH, PHD

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	48369	TX

General Provider Information

NPI Number	:	1558680736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PREMNATH V SHETTY RPH, PHD

Provider Business Mailing Address
First Line	:	5907 ABERCOMBIE LN
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-4666
Country	:	US
Telephone Number	:	972-375-7862
Fax Number	:

Provider Business Practice Location Address
First Line	:	16605 SOUTHWEST FWY STE 100
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-3475
Country	:	US
Telephone Number	:	281-980-0293
Fax Number	:

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

Provider Enumeration Date	:	05/27/2010
Last Update Date	:	04/13/2026

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