Healthcare Provider Details

I. General information

NPI: 1336705649
Provider Name (Legal Business Name): KAUSHAL SHAH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2019
Last Update Date: 05/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5184 STOCKDALE HWY
BAKERSFIELD CA
93309-2671
US

IV. Provider business mailing address

5184 STOCKDALE HWY
BAKERSFIELD CA
93309-2671
US

V. Phone/Fax

Practice location:
  • Phone: 661-633-2066
  • Fax:
Mailing address:
  • Phone: 661-633-2066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number63969
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: