Active NPI
Samir K Shah, RPH
- Pharmacist
- Liberty, NY
National Provider Identifier
1710166699
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 048917
- Practice address
- 187 Mill St
Liberty, NY 12754-2000 - Phone
- (845) 292-3430
- Fax
- (845) 292-3437
- NPI assigned
- Oct 29, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 048917 | NY | Primary |
Addresses
Primary practice location
187 Mill St
Liberty, NY 12754-2000
Mailing address
37 Grand View Ter
Chester, NY 10918-8201
Phone (845) 469-4618
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930081964 | NY | DME Supplier - Pharmacy | 2961693361 |
1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Liberty, NY |
Other NPIs on the same Medicare enrollment 1
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 048917 | NY | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1193616000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1698105600000",
"number": "1710166699",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "37 GRAND VIEW TER",
"city": "CHESTER",
"state": "NY",
"postal_code": "109188201",
"telephone_number": "845-469-4618"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "187 MILL ST",
"city": "LIBERTY",
"state": "NY",
"postal_code": "127542000",
"telephone_number": "845-292-3430",
"fax_number": "845-292-3437"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAH",
"first_name": "SAMIR",
"middle_name": "K",
"name_prefix": "Mr.",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-10-29",
"last_updated": "2023-10-24",
"certification_date": "2023-10-24",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "048917",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Liberty, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.