Provider Demographics
NPI:1942517735
Name:SHAH, RIZWAN AKHTAR (RPH,MS)
Entity type:Individual
Prefix:
First Name:RIZWAN
Middle Name:AKHTAR
Last Name:SHAH
Suffix:
Gender:M
Credentials:RPH,MS
Other - Prefix:
Other - First Name:SYED RIZWAN
Other - Middle Name:AKHTAR
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:103 CRAIN HWY N
Mailing Address - Street 2:SUITE B2
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-3096
Mailing Address - Country:US
Mailing Address - Phone:410-760-2290
Mailing Address - Fax:
Practice Address - Street 1:103 CRAIN HWY N
Practice Address - Street 2:SUITE B2
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-3096
Practice Address - Country:US
Practice Address - Phone:410-760-2290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-01
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14667183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist