Provider Demographics
NPI:1366767725
Name:SHAH, RAMESH A (RPH)
Entity type:Individual
Prefix:
First Name:RAMESH
Middle Name:A
Last Name:SHAH
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 1:22 TURNSTONE CIR
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13219-1555
Mailing Address - Country:US
Mailing Address - Phone:315-560-5372
Mailing Address - Fax:315-468-4005
Practice Address - Street 1:22 TURNSTONE CIR
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13219-1555
Practice Address - Country:US
Practice Address - Phone:315-560-5372
Practice Address - Fax:315-468-4005
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-29
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029996183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY183500000XMedicaid