Healthcare Provider Details

I. General information

NPI: 1366557894
Provider Name (Legal Business Name): SONAL SHAH RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2635 WESTFIELD AVE
CAMDEN NJ
08105-1132
US

IV. Provider business mailing address

14 JUSCHASE CT
VOORHEES NJ
08043-4861
US

V. Phone/Fax

Practice location:
  • Phone: 856-966-1112
  • Fax: 856-966-1181
Mailing address:
  • Phone: 856-767-1858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1676200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: