=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225240427
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHITAL MANEK PHARM D
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/03/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2051 S RIDGE RD
-----------------------------------------------------
City | MINOOKA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60447-8801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-467-1254
-----------------------------------------------------
Fax | 815-467-1516
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 24019 NORFOLK LN
-----------------------------------------------------
City | PLAINFIELD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60585-2273
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-609-6587
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 051.289559
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------