Provider Demographics
NPI:1174768022
Name:SHAH, UMANG S (PHARMACIST)
Entity type:Individual
Prefix:
First Name:UMANG
Middle Name:S
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 1:3719 OLD ALABAMA RD
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-8675
Mailing Address - Country:US
Mailing Address - Phone:770-475-8100
Mailing Address - Fax:
Practice Address - Street 1:3719 OLD ALABAMA RD
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-8675
Practice Address - Country:US
Practice Address - Phone:770-475-8100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-06
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH0023365183500000X
FLPS40911183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist