Provider Demographics
NPI:1366557894
Name:SHAH, SONAL (RPH)
Entity type:Individual
Prefix:MRS
First Name:SONAL
Middle Name:
Last Name:SHAH
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 1:14 JUSCHASE CT
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4861
Mailing Address - Country:US
Mailing Address - Phone:856-767-1858
Mailing Address - Fax:
Practice Address - Street 1:2635 WESTFIELD AVE
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08105-1132
Practice Address - Country:US
Practice Address - Phone:856-966-1112
Practice Address - Fax:856-966-1181
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1676200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0062375Medicaid
NJ0062367Medicaid
NJ0062375Medicaid