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NPI Code Detail

MEDICARE: MR. ASHISH K SHAH B.S. PHARMACY

MEDICARE: MR. ASHISH K SHAH B.S. PHARMACY
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
1183500000XPharmacistPS37285FL
2183500000XPharmacist5302034040MI

General Provider Information

NPI Number : 1639296379
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ASHISH K SHAH B.S. PHARMACY
Provider Business Mailing Address
First Line : 6123 MISSION DR
Second Line :
City : LAKELAND
State : FL
Zip : 33813-0816
Country : US
Telephone Number : 863-647-9028
Fax Number : 863-678-1829
Provider Business Practice Location Address
First Line : 1903 STATE ROAD 60 E
Second Line :
City : LAKE WALES
State : FL
Zip : 33853-4329
Country : US
Telephone Number : 863-676-9496
Fax Number : 863-678-1829
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/26/2007
Last Update Date : 07/08/2007

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