Healthcare Provider Details

I. General information

NPI: 1124483649
Provider Name (Legal Business Name): HIMANSHU SHUKLA RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2015
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 W HOLMES RD
LANSING MI
48910-0439
US

IV. Provider business mailing address

921 W HOLMES RD
LANSING MI
48910-0439
US

V. Phone/Fax

Practice location:
  • Phone: 517-393-7009
  • Fax: 517-393-0635
Mailing address:
  • Phone: 517-393-7009
  • Fax: 517-393-0635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number5302034906
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302034906
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: