Provider Demographics
NPI:1730457482
Name:REINHARDT, SHAWNA
Entity Type:Individual
Prefix:DR
First Name:SHAWNA
Middle Name:
Last Name:REINHARDT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 WAUKEGAN AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60040-1313
Mailing Address - Country:US
Mailing Address - Phone:847-433-5138
Mailing Address - Fax:
Practice Address - Street 1:320 WAUKEGAN AVE
Practice Address - Street 2:
Practice Address - City:HIGHWOOD
Practice Address - State:IL
Practice Address - Zip Code:60040-1313
Practice Address - Country:US
Practice Address - Phone:847-433-5138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-08
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.292817183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist