Provider Demographics
NPI:1942583570
Name:MASHRUWALA, SAMIR VINUBHAI
Entity Type:Individual
Prefix:MR
First Name:SAMIR
Middle Name:VINUBHAI
Last Name:MASHRUWALA
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 1:9033 HOLLYBERRY AVE
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-4216
Mailing Address - Country:US
Mailing Address - Phone:847-321-9409
Mailing Address - Fax:
Practice Address - Street 1:9033 HOLLYBERRY AVE
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-4216
Practice Address - Country:US
Practice Address - Phone:847-321-9409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051286876183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist