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NPI Code Detail

MEDICARE: MS. PURNIMA S. SHAH RPH, PHD

MEDICARE: MS. PURNIMA S. SHAH 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
1183500000XPharmacist28RI01907400NJ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
128RI01907400OTHERNJPHARMACIST LIC #

General Provider Information

NPI Number : 1699813295
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. PURNIMA S. SHAH RPH, PHD
Provider Business Mailing Address
First Line : 25 YALE CT
Second Line :
City : LIVINGSTON
State : NJ
Zip : 07039-1519
Country : US
Telephone Number : 973-533-0269
Fax Number : 973-533-0369
Provider Business Practice Location Address
First Line : 570 BLOOMFIELD AVE
Second Line :
City : NEWARK
State : NJ
Zip : 07107-1346
Country : US
Telephone Number : 973-482-6753
Fax Number : 973-482-0356
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/03/2007
Last Update Date : 07/08/2007

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