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General NPI Number Information
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NPI Number | 1104109032
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Entity Type | Individual
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Provider Name | DR. MITA SHAH
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Gender | Female
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Dates
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Enumeration Date | 09/27/2011
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Last Update Date | 09/27/2011
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Provider Practice Location Address
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Address Line | 12 S BLACK HORSE PIKE
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City | BELLMAWR
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State | NJ
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Zip | 08031-2305
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Country | US
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Telephone | 856-933-9342
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Fax |
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Provider Business Mailing Address
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Address Line | 9 ADAM CT
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City | MONROE
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State | NJ
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Zip | 08831-0167
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Country | US
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Telephone | 732-521-5310
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 28RI03023900
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License Number State | NJ
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