Healthcare Provider Details

I. General information

NPI: 1790007540
Provider Name (Legal Business Name): ASHA R SHAH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2010
Last Update Date: 02/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

733 N BEERS ST
HOLMDEL NJ
07733-1528
US

IV. Provider business mailing address

24 GREEN SPRINGS WAY
FREEHOLD NJ
07728-9071
US

V. Phone/Fax

Practice location:
  • Phone: 732-888-0303
  • Fax: 732-888-9621
Mailing address:
  • Phone: 732-313-6788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI02327700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: