MEDICARE: KIRTI Z SHAH INC

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	3336C0003X	Community/Retail Pharmacy	PHY30417	CA
2	332B00000X	Durable Medical Equipment & Medical Supplies		CA
3	333600000X	Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0531651	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1073524609
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIRTI Z SHAH INC

Provider Business Mailing Address
First Line	:	1600 S IMPERIAL AVE
Second Line	:	STE 12
City	:	EL CENTRO
State	:	CA
Zip	:	92243-4242
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 S IMPERIAL AVE
Second Line	:	STE 12
City	:	EL CENTRO
State	:	CA
Zip	:	92243-4242
Country	:	US
Telephone Number	:	760-353-5130
Fax Number	:	760-353-4556

Authorized Official
Title or Position	:	OWNER
Name	:	KIRTI SHAH
Credential	:	PHARM.D.
Telephone Number	:	760-353-5130

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	01/29/2013

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Directions to “KIRTI Z SHAH INC ” Practice Location

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