Provider Demographics
NPI:1730633751
Name:SHAH, DISHANT (RPH)
Entity type:Individual
Prefix:
First Name:DISHANT
Middle Name:
Last Name:SHAH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 SW PINE ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33991-2043
Mailing Address - Country:US
Mailing Address - Phone:239-574-9047
Mailing Address - Fax:239-800-6030
Practice Address - Street 1:301 SW PINE ISLAND RD
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33991-2043
Practice Address - Country:US
Practice Address - Phone:239-574-9047
Practice Address - Fax:239-800-6030
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-08
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS55088183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist