Provider Demographics
NPI:1962928598
Name:SHETH, AVANI (RPH)
Entity type:Individual
Prefix:
First Name:AVANI
Middle Name:
Last Name:SHETH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 1ST AVE W
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07107-2618
Mailing Address - Country:US
Mailing Address - Phone:973-482-8220
Mailing Address - Fax:973-482-0615
Practice Address - Street 1:195 1ST AVE W
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07107-2618
Practice Address - Country:US
Practice Address - Phone:973-482-8220
Practice Address - Fax:973-482-0615
Is Sole Proprietor?:No
Enumeration Date:2017-08-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02690900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist