Provider Demographics
NPI:1093134793
Name:AGARWAL, SHASHI (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:SHASHI
Middle Name:
Last Name:AGARWAL
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17930 WOLF RD
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-5412
Mailing Address - Country:US
Mailing Address - Phone:708-479-1744
Mailing Address - Fax:708-479-4634
Practice Address - Street 1:17930 WOLF RD
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-5412
Practice Address - Country:US
Practice Address - Phone:708-479-1744
Practice Address - Fax:708-479-4634
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-09
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-031504183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist