Provider Demographics
NPI:1669504106
Name:SHAH, PALLAVI JAGDISH (BS IN PHARMACY)
Entity Type:Individual
Prefix:MRS
First Name:PALLAVI
Middle Name:JAGDISH
Last Name:SHAH
Suffix:
Gender:F
Credentials:BS IN PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 DARIEN CLUB DR
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:IL
Mailing Address - Zip Code:60561-3667
Mailing Address - Country:US
Mailing Address - Phone:630-241-3607
Mailing Address - Fax:
Practice Address - Street 1:1919 DARIEN CLUB DR
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:IL
Practice Address - Zip Code:60561-3667
Practice Address - Country:US
Practice Address - Phone:630-241-3607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist