MEDICARE: PUJA 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	PS47557	FL

General Provider Information

NPI Number	:	1518584317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PUJA SHAH PHARMD

Provider Business Mailing Address
First Line	:	10814 CORY LAKE DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-2783
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10814 CORY LAKE DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-2783
Country	:	US
Telephone Number	:	678-787-4574
Fax Number	:

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

Provider Enumeration Date	:	06/29/2020
Last Update Date	:	06/29/2020

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