Provider Demographics
NPI:1851310833
Name:KALPESH M SHAH
Entity Type:Organization
Organization Name:KALPESH M SHAH
Other - Org Name:K AND K PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KALPESH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-667-4400
Mailing Address - Street 1:401 E 61ST ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-2324
Mailing Address - Country:US
Mailing Address - Phone:773-667-4400
Mailing Address - Fax:773-667-5040
Practice Address - Street 1:401 E 61ST ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-2324
Practice Address - Country:US
Practice Address - Phone:773-667-4400
Practice Address - Fax:773-667-5040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 333600000X
IL0540070533336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2017816OtherPK
IL359606117001Medicaid
4567130001Medicare NSC