MEDICARE: DR. AMITA SONI SHAH PHARM D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	051.292665	IL

General Provider Information

NPI Number	:	1518249044
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMITA SONI SHAH PHARM D.

Provider Business Mailing Address
First Line	:	235 W VAN BUREN ST
Second Line	:	UNIT 1705
City	:	CHICAGO
State	:	IL
Zip	:	60607-3918
Country	:	US
Telephone Number	:	630-903-1173
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 E ROOSEVELT RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60605-2410
Country	:	US
Telephone Number	:	312-212-1583
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/11/2011
Last Update Date	:	09/11/2011

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