Healthcare Provider Details

I. General information

NPI: 1013303684
Provider Name (Legal Business Name): SHILPA R TIKEKAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2015
Last Update Date: 04/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 S ESSEX AVE
ORANGE NJ
07050-3401
US

IV. Provider business mailing address

205 S ESSEX AVE
ORANGE NJ
07050-3401
US

V. Phone/Fax

Practice location:
  • Phone: 973-677-2800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI03630900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: