Individual provider Active NPI

Ketan H Shah, BS RPH

  • Pharmacist
  • Edison, NJ
National Provider Identifier
1407137102
Registry record updated Sep 8, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
28RI02170800 Issued in NJ
Practice address
153 Wood Ave
Edison, NJ 08820-3504
Phone
(732) 318-3046
Fax
(732) 379-5760
NPI assigned
Sep 8, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 28RI02170800 NJ Primary
Pharmacist 183500000X PS27026 FL

Addresses

Primary practice location

153 Wood Ave
Edison, NJ 08820-3504

Mailing address

153 Wood Ave
Edison, NJ 08820-3504
Phone (732) 318-3046

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Bachelor of Science, Registered Pharmacist

State licenses

LicenseStateTypeSpecialty
PS27026FLMDPharmacist
28RI02170800NJMDPharmacist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1315440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1315440000000",
    "number": "1407137102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "153 WOOD AVE",
            "city": "EDISON",
            "state": "NJ",
            "postal_code": "088203504",
            "telephone_number": "732-318-3046",
            "fax_number": "732-379-5760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "153 WOOD AVE",
            "city": "EDISON",
            "state": "NJ",
            "postal_code": "088203504",
            "telephone_number": "732-318-3046",
            "fax_number": "732-379-5760"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAH",
        "first_name": "KETAN",
        "middle_name": "H",
        "name_prefix": "Mr.",
        "credential": "BS RPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-09-08",
        "last_updated": "2011-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NJ",
            "license": "28RI02170800",
            "primary": true
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "FL",
            "license": "PS27026",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edison, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.