Provider Demographics
NPI:1902812068
Name:SHAH, RAVIN R (MS,RPH)
Entity Type:Individual
Prefix:
First Name:RAVIN
Middle Name:R
Last Name:SHAH
Suffix:
Gender:M
Credentials:MS,RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 FOREST HILL RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27295-2008
Mailing Address - Country:US
Mailing Address - Phone:336-224-6500
Mailing Address - Fax:336-224-6555
Practice Address - Street 1:124 FOREST HILL RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27295-2008
Practice Address - Country:US
Practice Address - Phone:336-224-6500
Practice Address - Fax:336-224-6555
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14729183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist