MEDICARE: DISHANT 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	PS55088	FL

General Provider Information

NPI Number	:	1730633751
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DISHANT SHAH RPH

Provider Business Mailing Address
First Line	:	301 SW PINE ISLAND RD
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33991-2043
Country	:	US
Telephone Number	:	239-574-9047
Fax Number	:	239-800-6030

Provider Business Practice Location Address
First Line	:	301 SW PINE ISLAND RD
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33991-2043
Country	:	US
Telephone Number	:	239-574-9047
Fax Number	:	239-800-6030

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

Provider Enumeration Date	:	08/08/2016
Last Update Date	:	08/08/2016

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