=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366537094
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEDSHOP PHARMACY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2006
-----------------------------------------------------
Last Update Date | 04/23/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 507 FAIRWAY DR SUITE 103
-----------------------------------------------------
City | NAPERVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60563-4051
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-961-8500
-----------------------------------------------------
Fax | 630-961-6105
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 507 FAIRWAY DR SUITE 103
-----------------------------------------------------
City | NAPERVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60563-4051
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-961-8500
-----------------------------------------------------
Fax | 630-961-6105
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. FATIMA PARISA ZAHRAEE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 630-961-8500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 51-038694
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 051038694
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------