MEDICARE: AVNI SAMIR SHAH PHARMD

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	28RI04182700	NJ

General Provider Information

NPI Number	:	1235701467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AVNI SAMIR SHAH PHARMD

Provider Business Mailing Address
First Line	:	38 KELLY WAY
Second Line	:
City	:	MONMOUTH JUNCTION
State	:	NJ
Zip	:	08852-2683
Country	:	US
Telephone Number	:	732-735-5877
Fax Number	:

Provider Business Practice Location Address
First Line	:	38 KELLY WAY
Second Line	:
City	:	MONMOUTH JUNCTION
State	:	NJ
Zip	:	08852-2683
Country	:	US
Telephone Number	:	732-735-5877
Fax Number	:

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

Provider Enumeration Date	:	07/16/2021
Last Update Date	:	07/16/2021

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