Provider Demographics
NPI:1457957300
Name:SHAH, KALYANI M (RPH)
Entity type:Individual
Prefix:
First Name:KALYANI
Middle Name:M
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 1:400 RENAISSANCE BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-5100
Mailing Address - Country:US
Mailing Address - Phone:732-940-9451
Mailing Address - Fax:
Practice Address - Street 1:400 RENAISSANCE BLVD
Practice Address - Street 2:
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-5100
Practice Address - Country:US
Practice Address - Phone:732-940-9451
Practice Address - Fax:732-940-7692
Is Sole Proprietor?:No
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02711200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist