Provider Demographics
NPI:1316261308
Name:SHAH, MEENA P (RPH)
Entity type:Individual
Prefix:MRS
First Name:MEENA
Middle Name:P
Last Name:SHAH
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 1:58 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NY
Mailing Address - Zip Code:13316-1338
Mailing Address - Country:US
Mailing Address - Phone:315-245-1410
Mailing Address - Fax:315-245-3339
Practice Address - Street 1:58 MAIN ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NY
Practice Address - Zip Code:13316-1338
Practice Address - Country:US
Practice Address - Phone:315-245-1410
Practice Address - Fax:315-245-3339
Is Sole Proprietor?:No
Enumeration Date:2010-03-18
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029994183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist