MEDICARE: KIRTIDA PANKAJ 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	044220-1	NY

General Provider Information

NPI Number	:	1619151156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRTIDA PANKAJ SHAH

Provider Business Mailing Address
First Line	:	7301 37TH AVE
Second Line	:	DUANE READE
City	:	JACKSON HEIGHT
State	:	NY
Zip	:	11372
Country	:	US
Telephone Number	:	718-672-8038
Fax Number	:	718-478-7928

Provider Business Practice Location Address
First Line	:	7301 37TH AVE
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-6326
Country	:	US
Telephone Number	:	718-672-8038
Fax Number	:	718-478-7928

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

Provider Enumeration Date	:	12/19/2007
Last Update Date	:	12/19/2007

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Directions to “ KIRTIDA PANKAJ SHAH ” Practice Location

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