Healthcare Provider Details

I. General information

NPI: 1366030587
Provider Name (Legal Business Name): MILY SHAH PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2021
Last Update Date: 07/29/2022
Certification Date: 07/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 NJ-70
MEDFORD NJ
08055
US

IV. Provider business mailing address

200 TUCKERTON RD
MEDFORD NJ
08055-8806
US

V. Phone/Fax

Practice location:
  • Phone: 609-654-7710
  • Fax:
Mailing address:
  • Phone: 856-983-9393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI04141600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: