Provider Demographics
NPI:1538445432
Name:SHAH, POOJA A (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:POOJA
Middle Name:A
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 1:108 JEWEL DR UNIT 208
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-8481
Mailing Address - Country:US
Mailing Address - Phone:314-497-1578
Mailing Address - Fax:
Practice Address - Street 1:5 E ANSON ST
Practice Address - Street 2:
Practice Address - City:MARSHALLTOWN
Practice Address - State:IA
Practice Address - Zip Code:50158-3347
Practice Address - Country:US
Practice Address - Phone:641-752-7181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA21196183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist