Provider Demographics
NPI:1972254621
Name:SHAH, SHRENIK D (PHARM D)
Entity Type:Individual
Prefix:
First Name:SHRENIK
Middle Name:D
Last Name:SHAH
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 BROUGHAM LN
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-2677
Mailing Address - Country:US
Mailing Address - Phone:630-965-4387
Mailing Address - Fax:
Practice Address - Street 1:6800 W ROUTE 34
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:IL
Practice Address - Zip Code:60545-9607
Practice Address - Country:US
Practice Address - Phone:630-552-3104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-14
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051303781183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist