Provider Demographics
NPI:1396992020
Name:SHETH, SANJIV (RPH)
Entity type:Individual
Prefix:
First Name:SANJIV
Middle Name:
Last Name:SHETH
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 1:1527 WESTCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10472-2908
Mailing Address - Country:US
Mailing Address - Phone:718-842-2777
Mailing Address - Fax:718-842-0077
Practice Address - Street 1:1528 WESTCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10472-2908
Practice Address - Country:US
Practice Address - Phone:718-842-2777
Practice Address - Fax:718-842-0077
Is Sole Proprietor?:No
Enumeration Date:2008-08-25
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047855-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist