Provider Demographics
NPI:1184313330
Name:SHAH, AMY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:
Last Name:SHAH
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 1:1255 TOWN CENTER RD UNIT 5O
Mailing Address - Street 2:
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-4196
Mailing Address - Country:US
Mailing Address - Phone:404-992-3765
Mailing Address - Fax:
Practice Address - Street 1:2621 S LAWNDALE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-4520
Practice Address - Country:US
Practice Address - Phone:773-542-9595
Practice Address - Fax:773-542-9590
Is Sole Proprietor?:No
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH0248182183500000X
IL051294650183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist