Healthcare Provider Details

I. General information

NPI: 1386649440
Provider Name (Legal Business Name): PATRICIA W SHAO PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5145 N CALIFORNIA AVE
CHICAGO IL
60625-3661
US

IV. Provider business mailing address

7239 N KEELER AVE
LINCOLNWOOD IL
60712-2020
US

V. Phone/Fax

Practice location:
  • Phone: 773-989-3810
  • Fax:
Mailing address:
  • Phone: 847-675-7591
  • Fax: 847-675-7592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: