Provider Demographics
NPI:1972783454
Name:SHUI, THEODORE (RPH)
Entity type:Individual
Prefix:
First Name:THEODORE
Middle Name:
Last Name:SHUI
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 1:3328 208TH ST
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-1319
Mailing Address - Country:US
Mailing Address - Phone:718-229-8426
Mailing Address - Fax:
Practice Address - Street 1:6129 SPRINGFIELD BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11364-2335
Practice Address - Country:US
Practice Address - Phone:718-428-8888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY33555183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00756017Medicaid