Provider Demographics
NPI:1962593699
Name:YAHYA, SHAH MOHAMMED (RPH)
Entity type:Individual
Prefix:MR
First Name:SHAH
Middle Name:MOHAMMED
Last Name:YAHYA
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 1:390 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CRISFIELD
Mailing Address - State:MD
Mailing Address - Zip Code:21817-1329
Mailing Address - Country:US
Mailing Address - Phone:410-968-1660
Mailing Address - Fax:410-968-9102
Practice Address - Street 1:390 W MAIN ST UNIT A
Practice Address - Street 2:
Practice Address - City:CRISFIELD
Practice Address - State:MD
Practice Address - Zip Code:21817
Practice Address - Country:US
Practice Address - Phone:410-968-1660
Practice Address - Fax:410-968-9102
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14326183500000X
PARP043949R183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010166268Medicaid
MD003150000Medicaid
MD14326OtherPHARMACY LICENSE NUMBER
MD408862000OtherMEDICAID DME
MD408862000OtherMEDICAID DME
MD5463320001Medicare NSC