Provider Demographics
NPI:1366937617
Name:SHUKLA, AVANI (PHARMD)
Entity type:Individual
Prefix:
First Name:AVANI
Middle Name:
Last Name:SHUKLA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3607 FOLEY GLEN CIR
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-3432
Mailing Address - Country:US
Mailing Address - Phone:810-969-0329
Mailing Address - Fax:
Practice Address - Street 1:3607 FOLEY GLEN CIR
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-3432
Practice Address - Country:US
Practice Address - Phone:810-969-0329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-28
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302042210183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist