Healthcare Provider Details

I. General information

NPI: 1558480905
Provider Name (Legal Business Name): PINANK PRAKASHBHAI SHAH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 07/10/2023
Certification Date: 07/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3147 W CERMAK RD
CHICAGO IL
60623-3307
US

IV. Provider business mailing address

2147 SILVER LINDEN LN
BUFFALO GROVE IL
60089-6631
US

V. Phone/Fax

Practice location:
  • Phone: 773-521-7422
  • Fax:
Mailing address:
  • Phone: 404-992-3764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH022832
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: