MEDICARE: KALPESH M SHAH

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
2	3336C0003X	Community/Retail Pharmacy	054007053	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2017816	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851310833
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KALPESH M SHAH

Provider Business Mailing Address
First Line	:	401 E 61ST ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60637-2324
Country	:	US
Telephone Number	:	773-667-4400
Fax Number	:	773-667-5040

Provider Business Practice Location Address
First Line	:	401 E 61ST ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60637-2324
Country	:	US
Telephone Number	:	773-667-4400
Fax Number	:	773-667-5040

Authorized Official
Title or Position	:	OWNER
Name	:	KALPESH SHAH
Credential	:
Telephone Number	:	773-667-4400

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	09/24/2014

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