Provider Demographics
NPI:1275101149
Name:MURRAY, SCOTT SHAWNTA
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:SHAWNTA
Last Name:MURRAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 W CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-5549
Mailing Address - Country:US
Mailing Address - Phone:773-799-9004
Mailing Address - Fax:773-799-9005
Practice Address - Street 1:2021 W CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-5549
Practice Address - Country:US
Practice Address - Phone:773-799-9004
Practice Address - Fax:773-799-9005
Is Sole Proprietor?:No
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0512903811835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist