Provider Demographics
NPI:1912084351
Name:GRIM, SHELLEE A (PHARMD)
Entity Type:Individual
Prefix:
First Name:SHELLEE
Middle Name:A
Last Name:GRIM
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 1:833 S WOOD ST
Mailing Address - Street 2:ROOM 164 MC 886
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-7229
Mailing Address - Country:US
Mailing Address - Phone:312-996-0870
Mailing Address - Fax:312-996-0379
Practice Address - Street 1:1740 W TAYLOR ST
Practice Address - Street 2:ROOM C300
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-7232
Practice Address - Country:US
Practice Address - Phone:312-996-3663
Practice Address - Fax:312-413-4146
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY012149183500000X
WAPH00040273183500000X
IL051.2896171835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No183500000XPharmacy Service ProvidersPharmacist