Healthcare Provider Details

I. General information

NPI: 1063508513
Provider Name (Legal Business Name): BHAILAL M SHAH R.PH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 E MCDOWELL 3RD FLOOR
PHOENIX AZ
85006
US

IV. Provider business mailing address

9812 N 86TH ST
SCOTTSDALE AZ
85258
US

V. Phone/Fax

Practice location:
  • Phone: 602-239-4792
  • Fax: 602-239-6790
Mailing address:
  • Phone: 480-483-8068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number6193
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: