Provider Demographics
NPI:1134435373
Name:SHAH, TRUPTI ATUL
Entity type:Individual
Prefix:
First Name:TRUPTI
Middle Name:ATUL
Last Name:SHAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3176 ENFIELD ST
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94582-5902
Mailing Address - Country:US
Mailing Address - Phone:925-560-9626
Mailing Address - Fax:
Practice Address - Street 1:1165 ARNOLD DR
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-4104
Practice Address - Country:US
Practice Address - Phone:925-372-0945
Practice Address - Fax:925-372-6516
Is Sole Proprietor?:No
Enumeration Date:2010-08-25
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59585183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist