MEDICARE: MR. ILESH J SHAH RPH

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		IL

General Provider Information

NPI Number	:	1598751224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ILESH J SHAH RPH

Provider Business Mailing Address
First Line	:	10419 VICTORIA CT
Second Line	:
City	:	MUNSTER
State	:	IN
Zip	:	46321-2827
Country	:	US
Telephone Number	:	773-264-1111
Fax Number	:

Provider Business Practice Location Address
First Line	:	11309 S MICHIGAN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60628-4911
Country	:	US
Telephone Number	:	773-264-1111
Fax Number	:

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

Provider Enumeration Date	:	09/27/2005
Last Update Date	:	07/08/2007

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