=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992137558
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RUSHI H SHAH PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/06/2013
-----------------------------------------------------
Last Update Date | 08/06/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4120 PALISADES CENTER DR
-----------------------------------------------------
City | WEST NYACK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10994-6801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-532-6378
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 160 N MAIN ST APT 6A
-----------------------------------------------------
City | NEW CITY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10956-3802
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-532-6372
-----------------------------------------------------
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 | 058285
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------