Healthcare Provider Details

I. General information

NPI: 1346615028
Provider Name (Legal Business Name): RAHUL SHAH PHARM D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2015
Last Update Date: 01/17/2022
Certification Date: 01/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 WOODLAND RD STE 100
SAINT HELENA CA
94574-9501
US

IV. Provider business mailing address

6 WOODLAND RD STE 100
SAINT HELENA CA
94574-9501
US

V. Phone/Fax

Practice location:
  • Phone: 707-963-5209
  • Fax: 707-967-5615
Mailing address:
  • Phone: 707-963-5209
  • Fax: 707-967-5615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS46364
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202215548
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0000040908
License Number StateTN
# 4
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number64373
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: