MEDICARE: DHAVALKUMAR 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	03233903	OH

General Provider Information

NPI Number	:	1154910289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DHAVALKUMAR SHAH RPH

Provider Business Mailing Address
First Line	:	35405 SPATTERDOCK LN
Second Line	:
City	:	SOLON
State	:	OH
Zip	:	44139-6500
Country	:	US
Telephone Number	:	419-283-7689
Fax Number	:

Provider Business Practice Location Address
First Line	:	3114 CLARK AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44109-1146
Country	:	US
Telephone Number	:	216-651-5700
Fax Number	:	216-744-2594

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

Provider Enumeration Date	:	01/13/2021
Last Update Date	:	01/13/2021

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Directions to “ DHAVALKUMAR SHAH RPH” Practice Location

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