Healthcare Provider Details

I. General information

NPI: 1700474533
Provider Name (Legal Business Name): PARSHVA SHAH PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2021
Last Update Date: 01/07/2021
Certification Date: 01/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 E IRVING PARK RD
ITASCA IL
60143-2300
US

IV. Provider business mailing address

1519 WHITE ST
DES PLAINES IL
60018-1740
US

V. Phone/Fax

Practice location:
  • Phone: 630-875-0244
  • Fax:
Mailing address:
  • Phone: 773-402-9639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051302995
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: