Healthcare Provider Details

I. General information

NPI: 1811598246
Provider Name (Legal Business Name): ZUWENA SHAVERS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2020
Last Update Date: 11/03/2020
Certification Date: 11/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 135TH ST
CRESTWOOD IL
60418-1405
US

IV. Provider business mailing address

2050 FAIRVIEW LN
SOUTH HOLLAND IL
60473-3781
US

V. Phone/Fax

Practice location:
  • Phone: 708-489-6476
  • Fax:
Mailing address:
  • Phone: 708-829-2553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051289128
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: