Provider Demographics
NPI:1962886069
Name:SHAH, RUSHABH (PHARMD)
Entity type:Individual
Prefix:
First Name:RUSHABH
Middle Name:
Last Name:SHAH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 RIVER CT APT 419
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07310-2018
Mailing Address - Country:US
Mailing Address - Phone:718-882-5614
Mailing Address - Fax:718-882-6365
Practice Address - Street 1:314 E 204TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-4602
Practice Address - Country:US
Practice Address - Phone:718-882-5614
Practice Address - Fax:718-882-6365
Is Sole Proprietor?:No
Enumeration Date:2015-07-17
Last Update Date:2015-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY060529183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist