Provider Demographics
NPI:1124311568
Name:SHAKER, MAI (RPH)
Entity type:Individual
Prefix:
First Name:MAI
Middle Name:
Last Name:SHAKER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 VILLAGE PLAZA WAY
Mailing Address - Street 2:
Mailing Address - City:N SCITUATE
Mailing Address - State:RI
Mailing Address - Zip Code:02857-1849
Mailing Address - Country:US
Mailing Address - Phone:401-934-2480
Mailing Address - Fax:401-934-2970
Practice Address - Street 1:548 DYER AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-5227
Practice Address - Country:US
Practice Address - Phone:401-942-9605
Practice Address - Fax:401-942-0371
Is Sole Proprietor?:No
Enumeration Date:2011-05-18
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRPH03869183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist