Active NPI
Sanjaykumar Kantilal Shah, RPH
- Pharmacist
- Lake Wales, FL
National Provider Identifier
1679747349
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS 43160
- Practice address
- 1903 State Road 60 E
Lake Wales, FL 33853-4329 - Phone
- (863) 676-9496
- Fax
- (863) 678-1829
- NPI assigned
- Apr 14, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PS 43160 | FL | Primary |
| Pharmacist | 183500000X | 45819 | TX |
Addresses
Primary practice location
1903 State Road 60 E
Lake Wales, FL 33853-4329
Mailing address
1903 State Road 60 E
Lake Wales, FL 33853-4329
Phone (863) 676-9496
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
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS 43160 | FL | MD | Pharmacist |
| 45819 | TX | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1208131200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1208131200000",
"number": "1679747349",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1903 STATE ROAD 60 E",
"city": "LAKE WALES",
"state": "FL",
"postal_code": "338534329",
"telephone_number": "863-676-9496",
"fax_number": "863-678-1829"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1903 STATE ROAD 60 E",
"city": "LAKE WALES",
"state": "FL",
"postal_code": "338534329",
"telephone_number": "863-676-9496",
"fax_number": "863-678-1829"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAH",
"first_name": "SANJAYKUMAR",
"middle_name": "KANTILAL",
"name_prefix": "Mr.",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-04-14",
"last_updated": "2008-04-14",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS 43160",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TX",
"license": "45819",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Wales, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.