Provider Demographics
NPI:1699309807
Name:SHAH, KASHMIRA A
Entity type:Individual
Prefix:
First Name:KASHMIRA
Middle Name:A
Last Name:SHAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2931 S FISH HATCHERY RD
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53711-6499
Mailing Address - Country:US
Mailing Address - Phone:608-277-0087
Mailing Address - Fax:608-277-0162
Practice Address - Street 1:2931 S FISH HATCHERY RD
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53711-6499
Practice Address - Country:US
Practice Address - Phone:608-277-0087
Practice Address - Fax:608-277-0162
Is Sole Proprietor?:No
Enumeration Date:2020-02-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI131740183500000X
WI13157183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist