MEDICARE: THOMAS SHAO

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	183500000X	Pharmacist	051-286082	IL

General Provider Information

NPI Number	:	1477558534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS SHAO

Provider Business Mailing Address
First Line	:	7239 N KEELER AVE
Second Line	:
City	:	LINCOLNWOOD
State	:	IL
Zip	:	60712-2020
Country	:	US
Telephone Number	:	773-769-7426
Fax Number	:

Provider Business Practice Location Address
First Line	:	7239 N KEELER AVE
Second Line	:
City	:	LINCOLNWOOD
State	:	IL
Zip	:	60712-2020
Country	:	US
Telephone Number	:	773-769-7426
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	03/07/2014

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Directions to “ THOMAS SHAO ” Practice Location

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