MEDICARE: SHARSHON PHARMACY INC

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	333600000X	Pharmacy	054019940	IL
2	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2159483	OTHER		PK

General Provider Information

NPI Number	:	1578598108
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHARSHON PHARMACY INC

Provider Business Mailing Address
First Line	:	931 W GALENA BLVD
Second Line	:
City	:	AURORA
State	:	IL
Zip	:	60506-3751
Country	:	US
Telephone Number	:	630-210-5307
Fax Number	:	630-892-5445

Provider Business Practice Location Address
First Line	:	402 PINE ST
Second Line	:
City	:	DELAVAN
State	:	IL
Zip	:	61734-7575
Country	:	US
Telephone Number	:	309-244-7115
Fax Number	:	309-244-7151

Authorized Official
Title or Position	:	OWNER
Name	:	WALTER SHARSHON
Credential	:
Telephone Number	:	630-210-5307

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	03/05/2018

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Directions to “SHARSHON PHARMACY INC ” Practice Location

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