Healthcare Provider Details

I. General information

NPI: 1629562624
Provider Name (Legal Business Name): SHIVANI PANKAJ SHAH PHARM.D., R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2018
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 S FETTERLY AVE
EAST LOS ANGELES CA
90022-1605
US

IV. Provider business mailing address

1574 RANCHO HILLS DR
CHINO HILLS CA
91709-6237
US

V. Phone/Fax

Practice location:
  • Phone: 909-993-4552
  • Fax:
Mailing address:
  • Phone: 909-993-4552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number78108
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: