Provider Demographics
NPI:1518249044
Name:SHAH, AMITA SONI (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:AMITA
Middle Name:SONI
Last Name:SHAH
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 W VAN BUREN ST
Mailing Address - Street 2:UNIT 1705
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-3918
Mailing Address - Country:US
Mailing Address - Phone:630-903-1173
Mailing Address - Fax:
Practice Address - Street 1:2 E ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-2410
Practice Address - Country:US
Practice Address - Phone:312-212-1583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-11
Last Update Date:2011-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.292665183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist