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General NPI Number Information
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NPI Number | 1700199403
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Entity Type | Individual
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Provider Name | MANSI SHAH PHARM.D
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Gender | Female
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Dates
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Enumeration Date | 07/22/2010
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Last Update Date | 07/22/2010
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Provider Practice Location Address
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Address Line | 1901 W. HARRISON ST.
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City | CHICAGO
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State | IL
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Zip | 60612
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Country | US
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Telephone | 312-333-8918
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Fax |
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Provider Business Mailing Address
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Address Line | 91 W. 18TH ST.
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City | LOMBARD
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State | IL
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Zip | 60148
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Country | US
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Telephone | 630-620-5019
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 051.294051
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License Number State | IL
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