Provider Demographics
NPI:1578598108
Name:SHARSHON PHARMACY INC
Entity Type:Organization
Organization Name:SHARSHON PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARSHON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-210-5307
Mailing Address - Street 1:931 W GALENA BLVD
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-3751
Mailing Address - Country:US
Mailing Address - Phone:630-210-5307
Mailing Address - Fax:630-892-5445
Practice Address - Street 1:402 PINE ST
Practice Address - Street 2:
Practice Address - City:DELAVAN
Practice Address - State:IL
Practice Address - Zip Code:61734-7575
Practice Address - Country:US
Practice Address - Phone:309-244-7115
Practice Address - Fax:309-244-7151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL054019940333600000X
3336C0003X
IL0540146243336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2159483OtherPK
IL4303720001Medicare NSC