Provider Demographics
NPI:1942345749
Name:SHAH, HEMENDRA S
Entity Type:Individual
Prefix:MR
First Name:HEMENDRA
Middle Name:S
Last Name:SHAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 SPRING VALLEY CT
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60193-4300
Mailing Address - Country:US
Mailing Address - Phone:847-891-6688
Mailing Address - Fax:
Practice Address - Street 1:3900 W MADISON ST
Practice Address - Street 2:13
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60624-2354
Practice Address - Country:US
Practice Address - Phone:773-722-4405
Practice Address - Fax:773-722-1200
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1835P0018X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL363685567001Medicaid
IL363685567001Medicaid