Healthcare Provider Details

I. General information

NPI: 1093769176
Provider Name (Legal Business Name): SHIV PHARMACY INCORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2006
Last Update Date: 01/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1608 W 69TH ST
CHICAGO IL
60636-3316
US

IV. Provider business mailing address

1608 W 69TH ST
CHICAGO IL
60636-3316
US

V. Phone/Fax

Practice location:
  • Phone: 773-778-3420
  • Fax:
Mailing address:
  • Phone: 773-778-3420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number54011132
License Number StateIL

VIII. Authorized Official

Name: ARUN PATEL
Title or Position: PRESIDENT
Credential:
Phone: 773-778-3420