Healthcare Provider Details

I. General information

NPI: 1073982526
Provider Name (Legal Business Name): NIKITA SHAH PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2015
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

361 GEORGE W LILES PKWY NW
CONCORD NC
28027-6532
US

IV. Provider business mailing address

361 GEORGE W LILES PKWY NW
CONCORD NC
28027-6532
US

V. Phone/Fax

Practice location:
  • Phone: 704-789-9681
  • Fax:
Mailing address:
  • Phone: 704-789-9781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number36330
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number29271
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number80142
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: