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General NPI Number Information
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NPI Number | 1518333178
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Entity Type | Individual
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Provider Name | KIRTI MUKESHKUMAR SHAH R.PH
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Gender | Male
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Dates
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Enumeration Date | 08/18/2015
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Last Update Date | 08/18/2015
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Provider Practice Location Address
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Address Line | 1555 S AVENUE B
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City | YUMA
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State | AZ
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Zip | 85364-4324
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Country | US
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Telephone | 928-519-0208
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Fax |
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Provider Business Mailing Address
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Address Line | 11724 E 28TH PL
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City | YUMA
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State | AZ
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Zip | 85367-3603
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Country | US
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Telephone | 617-971-6906
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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 | S021497
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License Number State | AZ
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