Provider Demographics
NPI:1487956231
Name:MALIK, SHAH N (RPH)
Entity type:Individual
Prefix:
First Name:SHAH
Middle Name:N
Last Name:MALIK
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 1:17779 LOWER BOONES FERRY RD
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-5237
Mailing Address - Country:US
Mailing Address - Phone:503-675-2509
Mailing Address - Fax:503-675-2512
Practice Address - Street 1:17779 LOWER BOONES FERRY RD
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-5237
Practice Address - Country:US
Practice Address - Phone:503-675-2509
Practice Address - Fax:503-675-2512
Is Sole Proprietor?:No
Enumeration Date:2010-11-30
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6052183500000X
WAPH00010260183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist