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General NPI Number Information
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NPI Number | 1649706276
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Entity Type | Organization
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Legal Business Name | SHIVAAY 1 PLLC
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Dates
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Enumeration Date | 05/02/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 6869 S OCCIDENTAL HIGHWAY
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City | TECUMSEH
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State | MI
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Zip | 49286
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Country | US
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Telephone | 517-301-4555
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Fax | 517-301-4556
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Provider Business Mailing Address
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Address Line | 305 W CANFORD PARK
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City | CANTON
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State | MI
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Zip | 48187
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Country | US
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Telephone | 517-301-4555
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Fax | 517-301-4556
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | DHIMAN PATEL
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Credential |
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Telephone | 704-807-6200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 5301011162
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License Number State | MI
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