Healthcare Provider Details

I. General information

NPI: 1114922796
Provider Name (Legal Business Name): SAURABH H SHETH RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: SAM H SHETH RPH

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 05/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111-BEDFORD AVE
BELLMORE NY
11710
US

IV. Provider business mailing address

42 KEMI LN
SAYVILLE NY
11782-1150
US

V. Phone/Fax

Practice location:
  • Phone: 516-221-4022
  • Fax:
Mailing address:
  • Phone: 631-732-3268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number044206
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: