MEDICARE: DR. SUNNY T SHETH PHARMD, MBA, 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	28RI04335400	NJ

General Provider Information

NPI Number	:	1902654171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUNNY T SHETH PHARMD, MBA, RPH

Provider Business Mailing Address
First Line	:	16 BROWN CT
Second Line	:
City	:	LIVINGSTON
State	:	NJ
Zip	:	07039-1520
Country	:	US
Telephone Number	:	973-796-7388
Fax Number	:

Provider Business Practice Location Address
First Line	:	195 1ST AVE W
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07107-2618
Country	:	US
Telephone Number	:	973-482-8220
Fax Number	:

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

Provider Enumeration Date	:	05/10/2024
Last Update Date	:	05/10/2024

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