Healthcare Provider Details

I. General information

NPI: 1366537094
Provider Name (Legal Business Name): MEDSHOP PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 04/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 FAIRWAY DR SUITE 103
NAPERVILLE IL
60563-4051
US

IV. Provider business mailing address

507 FAIRWAY DR SUITE 103
NAPERVILLE IL
60563-4051
US

V. Phone/Fax

Practice location:
  • Phone: 630-961-8500
  • Fax: 630-961-6105
Mailing address:
  • Phone: 630-961-8500
  • Fax: 630-961-6105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number051038694
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number51-038694
License Number StateIL

VIII. Authorized Official

Name: DR. FATIMA PARISA ZAHRAEE
Title or Position: OWNER
Credential:
Phone: 630-961-8500