Provider Demographics
NPI:1801179486
Name:SHALABI, IDA (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:IDA
Middle Name:
Last Name:SHALABI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MRS
Other - First Name:IDA
Other - Middle Name:
Other - Last Name:MORETTI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:4819 WEST 96TH STREET
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453
Mailing Address - Country:US
Mailing Address - Phone:773-818-1446
Mailing Address - Fax:
Practice Address - Street 1:4740 WEST 95TH STREET
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453
Practice Address - Country:US
Practice Address - Phone:708-425-6960
Practice Address - Fax:708-425-9543
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-288898183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist