Provider Demographics
NPI:1962723221
Name:SHAH, DIPAKKUMAR B (PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:DIPAKKUMAR
Middle Name:B
Last Name:SHAH
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13059 BULLET AVE
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-6327
Mailing Address - Country:US
Mailing Address - Phone:760-955-2594
Mailing Address - Fax:
Practice Address - Street 1:19035 BEAR VALLEY RD
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92308-2712
Practice Address - Country:US
Practice Address - Phone:760-961-7325
Practice Address - Fax:760-961-2213
Is Sole Proprietor?:No
Enumeration Date:2010-06-21
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46006183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist