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General NPI Number Information
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NPI Number | 1568864643
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Entity Type | Individual
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Provider Name | ISHAN SHAH
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Gender | Male
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Dates
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Enumeration Date | 09/20/2014
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Last Update Date | 09/20/2014
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Provider Practice Location Address
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Address Line | 1197 AMBOY AVE
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City | EDISON
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State | NJ
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Zip | 08837-2536
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Country | US
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Telephone | 732-549-3875
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Fax |
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Provider Business Mailing Address
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Address Line | 1901 GREEN HOLLOW DR
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City | ISELIN
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State | NJ
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Zip | 08830-2950
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Country | US
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Telephone | 732-589-9547
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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 | 28RI03657800
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License Number State | NJ
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