MEDICARE: SUCHITKUMAR 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	5302037618	MI

General Provider Information

NPI Number	:	1215171699
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUCHITKUMAR SHAH

Provider Business Mailing Address
First Line	:	305 E STATE ST
Second Line	:
City	:	CASSOPOLIS
State	:	MI
Zip	:	49031-1328
Country	:	US
Telephone Number	:	269-445-5369
Fax Number	:

Provider Business Practice Location Address
First Line	:	305 E STATE ST
Second Line	:
City	:	CASSOPOLIS
State	:	MI
Zip	:	49031-1328
Country	:	US
Telephone Number	:	269-445-5369
Fax Number	:

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

Provider Enumeration Date	:	04/29/2009
Last Update Date	:	04/29/2009

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Directions to “ SUCHITKUMAR SHAH ” Practice Location

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