Healthcare Provider Details

I. General information

NPI: 1144389305
Provider Name (Legal Business Name): NUTAN MOTICHAND SHAH RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6002 N LAPEER RD
NORTH BRANCH MI
48461-9730
US

IV. Provider business mailing address

36957 ASPEN DR
FARMINGTON HILLS MI
48335-5487
US

V. Phone/Fax

Practice location:
  • Phone: 810-793-5006
  • Fax: 810-793-5101
Mailing address:
  • Phone: 248-442-1477
  • Fax: 248-442-1477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302026181
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: