MEDICARE: MR. NUTAN MOTICHAND SHAH RPH

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	5302026181	MI

General Provider Information

NPI Number	:	1144389305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NUTAN MOTICHAND SHAH RPH

Provider Business Mailing Address
First Line	:	36957 ASPEN DR
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48335-5487
Country	:	US
Telephone Number	:	248-442-1477
Fax Number	:	248-442-1477

Provider Business Practice Location Address
First Line	:	6002 N LAPEER RD
Second Line	:
City	:	NORTH BRANCH
State	:	MI
Zip	:	48461-9730
Country	:	US
Telephone Number	:	810-793-5006
Fax Number	:	810-793-5101

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

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	07/08/2007

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