Provider Demographics
NPI:1407206931
Name:KASHANI, SHADI (PHARMD)
Entity Type:Individual
Prefix:MS
First Name:SHADI
Middle Name:
Last Name:KASHANI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 N. MARINE DRIVE
Mailing Address - Street 2:APT 6F
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646
Mailing Address - Country:US
Mailing Address - Phone:630-862-0608
Mailing Address - Fax:
Practice Address - Street 1:4054 W ROSEMONT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-4532
Practice Address - Country:US
Practice Address - Phone:630-862-0608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-15
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051297336183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist