1588250617 NPI number — DR. SMITI SHAH PHARMD

Table of content: DR. SMITI SHAH PHARMD (NPI 1588250617)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588250617 NPI number — DR. SMITI SHAH PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHAH
Provider First Name:
SMITI
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588250617
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/14/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11948 BROWNWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRISCO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75035-8862
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
347-260-2883
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 W CRAWFORD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENISON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75020-4699
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-465-6182
Provider Business Practice Location Address Fax Number:
903-463-4772
Provider Enumeration Date:
12/13/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  60567 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 183500000X , with the licence number: 15801 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 60567 . This is a "TEXAS STATE BOARD OF PHARMACY" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 15801 . This is a "OKLAHOMA STATE BOARD OF PHARMACY" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".