MEDICARE: SHIV PHARMACY INCORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	54011132	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1460853	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1093769176
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHIV PHARMACY INCORPORATION

Provider Business Mailing Address
First Line	:	1608 W 69TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60636-3316
Country	:	US
Telephone Number	:	773-778-3420
Fax Number	:

Provider Business Practice Location Address
First Line	:	1608 W 69TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60636-3316
Country	:	US
Telephone Number	:	773-778-3420
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ARUN PATEL
Credential	:
Telephone Number	:	773-778-3420

Provider Enumeration Date	:	05/21/2006
Last Update Date	:	01/19/2010

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Directions to “SHIV PHARMACY INCORPORATION ” Practice Location

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