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General NPI Number Information
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NPI Number | 1164630497
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Entity Type | Organization
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Legal Business Name | SHARDA PHARMACY,INC.
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 03/16/2010
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Provider Practice Location Address
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Address Line | 1301 S ASHLAND AVE
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City | CHICAGO
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State | IL
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Zip | 60608-1300
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Country | US
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Telephone | 312-666-0240
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Fax | 312-733-0765
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Provider Business Mailing Address
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Address Line | 1301 S ASHLAND AVE
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City | CHICAGO
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State | IL
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Zip | 60608-1300
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Country | US
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Telephone | 312-666-0240
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Fax | 312-733-0765
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | MR. AJAY H SHAH
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Credential | RPH
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Telephone | 312-666-0240
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 054011064
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License Number State | IL
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