Healthcare Provider Details

I. General information

NPI: 1780289983
Provider Name (Legal Business Name): SHIV A AGHARA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2020
Last Update Date: 12/03/2020
Certification Date: 12/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24802 ALDINE WESTFIELD RD
SPRING TX
77373-5926
US

IV. Provider business mailing address

205 DOVE MEADOW DR
CONROE TX
77384-1401
US

V. Phone/Fax

Practice location:
  • Phone: 281-288-1561
  • Fax:
Mailing address:
  • Phone: 480-882-8257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number55680
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: