Provider Demographics
NPI:1356614580
Name:SHAH, PURVI H (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:PURVI
Middle Name:H
Last Name:SHAH
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 1:285 AYCRIGG AVE APT 14A
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-3730
Mailing Address - Country:US
Mailing Address - Phone:302-359-0586
Mailing Address - Fax:
Practice Address - Street 1:111 CENTRAL AVE FL 1
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-1909
Practice Address - Country:US
Practice Address - Phone:973-877-5174
Practice Address - Fax:855-205-4531
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-19
Last Update Date:2025-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03402700183500000X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist