Healthcare Provider Details

I. General information

NPI: 1508091042
Provider Name (Legal Business Name): SANGITA A SHAH RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2009
Last Update Date: 05/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5225 CANYON CREST DR STE 8
RIVERSIDE CA
92507-6320
US

IV. Provider business mailing address

5225 CANYON CREST DR STE 8
RIVERSIDE CA
92507-6320
US

V. Phone/Fax

Practice location:
  • Phone: 951-686-2203
  • Fax: 951-686-4980
Mailing address:
  • Phone: 951-686-2203
  • Fax: 951-686-4980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number42359
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: