Provider Demographics
NPI:1104314749
Name:SHAH, VIRAL (BPHARM)
Entity type:Individual
Prefix:
First Name:VIRAL
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:BPHARM
Other - Prefix:
Other - First Name:VIRAL
Other - Middle Name:
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1567 CRESTVIEW RD
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-6378
Mailing Address - Country:US
Mailing Address - Phone:714-262-1115
Mailing Address - Fax:
Practice Address - Street 1:4210 HIGHLAND AVE # K
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:CA
Practice Address - Zip Code:92346-2742
Practice Address - Country:US
Practice Address - Phone:909-425-8687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-30
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55514183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA55514OtherBOARD OF PHARMACY