Provider Demographics
NPI:1538789854
Name:PAUL, SHILPI (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SHILPI
Middle Name:
Last Name:PAUL
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 1:2720 S BRISTOL ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-6207
Mailing Address - Country:US
Mailing Address - Phone:714-601-4610
Mailing Address - Fax:
Practice Address - Street 1:2720 S BRISTOL ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-6207
Practice Address - Country:US
Practice Address - Phone:714-601-4610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-17
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80898183500000X
CAPHY45606333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Yes183500000XPharmacy Service ProvidersPharmacist
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA456060Medicaid
CA0563533OtherOTHER ID NUMBER-COMMERCIAL NUMBER