Provider Demographics
NPI:1003320318
Name:SHAH, SUHANI SHAIL
Entity Type:Individual
Prefix:
First Name:SUHANI
Middle Name:SHAIL
Last Name:SHAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SUHANI
Other - Middle Name:SUHAS
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SUHANI SUHAS SHAH
Mailing Address - Street 1:545 GREENVIEW LANE
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090
Mailing Address - Country:US
Mailing Address - Phone:224-310-8325
Mailing Address - Fax:
Practice Address - Street 1:BROADWAY AVE PHARMACY
Practice Address - Street 2:151 N 19TH AVE
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60090
Practice Address - Country:US
Practice Address - Phone:708-450-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051300513183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist