MEDICARE: DR. ABHISHEK SHAH R.PH, PH.D

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	28RI03750400	NJ

General Provider Information

NPI Number	:	1528429693
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ABHISHEK SHAH R.PH, PH.D

Provider Business Mailing Address
First Line	:	3229 JOHN F KENNEDY BLVD
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07306-3405
Country	:	US
Telephone Number	:	856-577-3560
Fax Number	:

Provider Business Practice Location Address
First Line	:	3229 JOHN F KENNEDY BLVD
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07306-3405
Country	:	US
Telephone Number	:	856-577-3560
Fax Number	:

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

Provider Enumeration Date	:	03/16/2016
Last Update Date	:	03/16/2016

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