Provider Demographics
NPI:1215254628
Name:JOSEPH, SHAJI
Entity type:Individual
Prefix:MR
First Name:SHAJI
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 W LYNFORD RD
Mailing Address - Street 2:
Mailing Address - City:RICHBORO
Mailing Address - State:PA
Mailing Address - Zip Code:18954-1379
Mailing Address - Country:US
Mailing Address - Phone:215-778-8350
Mailing Address - Fax:215-942-2327
Practice Address - Street 1:7401 OGONTZ AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19138-1323
Practice Address - Country:US
Practice Address - Phone:215-224-9997
Practice Address - Fax:215-224-3922
Is Sole Proprietor?:No
Enumeration Date:2010-04-23
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP040861L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist