Provider Demographics
NPI:1124483649
Name:SHUKLA, HIMANSHU (RPH)
Entity type:Individual
Prefix:
First Name:HIMANSHU
Middle Name:
Last Name:SHUKLA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18430 FENKELL ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48223-2301
Mailing Address - Country:US
Mailing Address - Phone:313-837-2340
Mailing Address - Fax:313-837-0884
Practice Address - Street 1:18430 FENKELL ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48223-2301
Practice Address - Country:US
Practice Address - Phone:313-837-2340
Practice Address - Fax:313-837-0884
Is Sole Proprietor?:No
Enumeration Date:2015-12-29
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302034906183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist