Healthcare Provider Details

I. General information

NPI: 1073524609
Provider Name (Legal Business Name): KIRTI Z SHAH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 01/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 S IMPERIAL AVE STE 12
EL CENTRO CA
92243-4242
US

IV. Provider business mailing address

1600 S IMPERIAL AVE STE 12
EL CENTRO CA
92243-4242
US

V. Phone/Fax

Practice location:
  • Phone: 760-353-5130
  • Fax: 760-353-4556
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY30417
License Number StateCA

VIII. Authorized Official

Name: KIRTI SHAH
Title or Position: OWNER
Credential: PHARM.D.
Phone: 760-353-5130