MEDICARE: DR. DHRUVA SHAH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RP0000813	NM

General Provider Information

NPI Number	:	1043689755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DHRUVA SHAH

Provider Business Mailing Address
First Line	:	1202 N RIVERSIDE DR
Second Line	:
City	:	ESPANOLA
State	:	NM
Zip	:	87532-2976
Country	:	US
Telephone Number	:	505-367-3594
Fax Number	:

Provider Business Practice Location Address
First Line	:	1202 N RIVERSIDE DR
Second Line	:
City	:	ESPANOLA
State	:	NM
Zip	:	87532-2976
Country	:	US
Telephone Number	:	505-367-3594
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2015
Last Update Date	:	09/23/2015

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Directions to “ DR. DHRUVA SHAH ” Practice Location

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