Provider Demographics
NPI:1245513316
Name:SHAH, AVNI NARENDRA (PHARM-D)
Entity type:Individual
Prefix:
First Name:AVNI
Middle Name:NARENDRA
Last Name:SHAH
Suffix:
Gender:F
Credentials:PHARM-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14656 AMBAUM BLVD SW
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-1810
Mailing Address - Country:US
Mailing Address - Phone:608-239-5336
Mailing Address - Fax:
Practice Address - Street 1:14656 AMBAUM BLVD SW
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-1810
Practice Address - Country:US
Practice Address - Phone:206-901-1816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-24
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14699-49183500000X
WAPH60053734183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist