MEDICARE: MITTAL 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	44403	TX

General Provider Information

NPI Number	:	1891022786
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MITTAL SHAH

Provider Business Mailing Address
First Line	:	6768 HIGHWAY 6 S
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77083-1512
Country	:	US
Telephone Number	:	281-530-9768
Fax Number	:	281-568-4725

Provider Business Practice Location Address
First Line	:	6768 HIGHWAY 6 S
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77083-1512
Country	:	US
Telephone Number	:	281-530-9768
Fax Number	:	281-568-4725

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

Provider Enumeration Date	:	11/12/2009
Last Update Date	:	11/12/2009

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Directions to “ MITTAL SHAH ” Practice Location

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