Provider Demographics
NPI:1437746567
Name:MOTON, SHKIRAH (PHARMD)
Entity Type:Individual
Prefix:
First Name:SHKIRAH
Middle Name:
Last Name:MOTON
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 1:5152 PEARSON ST
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-3112
Mailing Address - Country:US
Mailing Address - Phone:708-238-9423
Mailing Address - Fax:
Practice Address - Street 1:225 JOLIET ST
Practice Address - Street 2:
Practice Address - City:DYER
Practice Address - State:IN
Practice Address - Zip Code:46311-1709
Practice Address - Country:US
Practice Address - Phone:219-322-3014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26029103A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1952798993OtherPHARMACY