Provider Demographics
NPI:1114221751
Name:MEDSHOP PHARMACY LLC
Entity Type:Organization
Organization Name:MEDSHOP PHARMACY LLC
Other - Org Name:MEDSHOP PHARMACY LLC OF AURORA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARM.D., R.PH
Authorized Official - Prefix:
Authorized Official - First Name:FATIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAHRAEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-961-8500
Mailing Address - Street 1:3535 E NEW YORK ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-4465
Mailing Address - Country:US
Mailing Address - Phone:630-961-1600
Mailing Address - Fax:
Practice Address - Street 1:3535 E NEW YORK ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-4465
Practice Address - Country:US
Practice Address - Phone:630-961-1600
Practice Address - Fax:630-536-5389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-22
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
IL0540175913336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1485261OtherNCPDP PROVIDER IDENTIFICATION NUMBER