Provider Demographics
NPI:1871911453
Name:NATHWANI, SHRITI MANISH
Entity type:Individual
Prefix:
First Name:SHRITI
Middle Name:MANISH
Last Name:NATHWANI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3414 8TH ST SW
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:IA
Mailing Address - Zip Code:50009-1024
Mailing Address - Country:US
Mailing Address - Phone:515-967-1885
Mailing Address - Fax:
Practice Address - Street 1:3414 8TH ST SW
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:IA
Practice Address - Zip Code:50009-1024
Practice Address - Country:US
Practice Address - Phone:515-967-1885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-01
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA22176183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist