Healthcare Provider Details

I. General information

NPI: 1962731794
Provider Name (Legal Business Name): RUPAL R SHAH B. PHARM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2009
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25401 N LAKE PLEASANT PKWY
PEORIA AZ
85383-1351
US

IV. Provider business mailing address

10675 W INDIAN SCHOOL RD
AVONDALE AZ
85392-5645
US

V. Phone/Fax

Practice location:
  • Phone: 623-235-2360
  • Fax: 623-235-2361
Mailing address:
  • Phone: 623-772-0502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS012411
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: