=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336573260
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AJAY K SHUKLA PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/27/2013
-----------------------------------------------------
Last Update Date | 03/17/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3401 PRINCETON PIKE RM C.4254H
-----------------------------------------------------
City | LAWRENCEVILLE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08648-1205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-302-5778
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3401 PRINCETON PIKE ROOM C.4254H
-----------------------------------------------------
City | LAWRENCE TOWNSHIP
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08648
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 28RI03574400
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------