Provider Demographics
NPI:1023361607
Name:SHUKLA, SAGAR JAYANT (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SAGAR
Middle Name:JAYANT
Last Name:SHUKLA
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 1:22 KIMMIE CT
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-1746
Mailing Address - Country:US
Mailing Address - Phone:302-463-6124
Mailing Address - Fax:
Practice Address - Street 1:1927 EMMORTON RD
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-6203
Practice Address - Country:US
Practice Address - Phone:410-838-8573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-20
Last Update Date:2012-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20574183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist