Healthcare Provider Details

I. General information

NPI: 1629346739
Provider Name (Legal Business Name): SHEETAL SHAH PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2011
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 W I PKWY STE 500
DALLAS GA
30132-0972
US

IV. Provider business mailing address

311 W I PKWY STE 500
DALLAS GA
30132-0972
US

V. Phone/Fax

Practice location:
  • Phone: 770-615-0951
  • Fax:
Mailing address:
  • Phone: 770-615-0951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number020902
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: