Provider Demographics
NPI:1134463995
Name:SHAW, TRISHIA E (PHARMD)
Entity type:Individual
Prefix:
First Name:TRISHIA
Middle Name:E
Last Name:SHAW
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4516 S VINCENNES AVE UNIT BNK
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60653-3470
Mailing Address - Country:US
Mailing Address - Phone:773-580-5797
Mailing Address - Fax:
Practice Address - Street 1:4909 W DIVISION ST STE 305
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60651-3100
Practice Address - Country:US
Practice Address - Phone:773-921-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.293846183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist