Healthcare Provider Details

I. General information

NPI: 1356254601
Provider Name (Legal Business Name): YESHA SHAH PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 PATRIOT BLVD
GLENVIEW IL
60026-7777
US

IV. Provider business mailing address

8210 ELMWOOD AVE APT 404
SKOKIE IL
60077-2975
US

V. Phone/Fax

Practice location:
  • Phone: 847-657-8691
  • Fax: 847-657-9173
Mailing address:
  • Phone: 224-400-0678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051309482
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: