MEDICARE: TRUSHAR SHETH R.PH.

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	28RI02128100	NJ

General Provider Information

NPI Number	:	1073854063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRUSHAR SHETH R.PH.

Provider Business Mailing Address
First Line	:	PO BOX 110
Second Line	:
City	:	BLOOMFIELD
State	:	NJ
Zip	:	07003-0110
Country	:	US
Telephone Number	:	973-482-8220
Fax Number	:	973-482-0615

Provider Business Practice Location Address
First Line	:	195 1ST AVE W
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07107-2618
Country	:	US
Telephone Number	:	973-482-8220
Fax Number	:	973-482-0615

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

Provider Enumeration Date	:	03/15/2013
Last Update Date	:	03/15/2013

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