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General NPI Number Information
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NPI Number | 1912084351
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Entity Type | Individual
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Provider Name | SHELLEE A GRIM PHARM.D.
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Gender | Female
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 10/06/2008
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Provider Practice Location Address
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Address Line | 1740 W TAYLOR ST ROOM C300
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City | CHICAGO
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State | IL
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Zip | 60612-7232
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Country | US
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Telephone | 312-996-3663
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Fax | 312-413-4146
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Provider Business Mailing Address
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Address Line | 833 S WOOD ST ROOM 164 MC 886
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City | CHICAGO
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State | IL
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Zip | 60612-7229
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Country | US
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Telephone | 312-996-0870
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Fax | 312-996-0379
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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 | 012149
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PH00040273
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number | 051.289617
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License Number State | IL
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