Provider Demographics
NPI:1154982965
Name:SHAH, RITABEN DARSHIT
Entity type:Individual
Prefix:
First Name:RITABEN
Middle Name:DARSHIT
Last Name:SHAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11969 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:GA
Mailing Address - Zip Code:30752-2855
Mailing Address - Country:US
Mailing Address - Phone:706-500-1301
Mailing Address - Fax:706-500-1302
Practice Address - Street 1:11559 S MAIN ST APT 2
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:GA
Practice Address - Zip Code:30752-2821
Practice Address - Country:US
Practice Address - Phone:423-475-2987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-23
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN41899183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist