Provider Demographics
NPI:1679902589
Name:SHAH, DHIMANT KAUSHIK (PHARMD)
Entity type:Individual
Prefix:
First Name:DHIMANT
Middle Name:KAUSHIK
Last Name:SHAH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 S FRONTAGE RD
Mailing Address - Street 2:SUITE 1900
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-4946
Mailing Address - Country:US
Mailing Address - Phone:630-985-7189
Mailing Address - Fax:630-985-7438
Practice Address - Street 1:940 S FRONTAGE RD
Practice Address - Street 2:SUITE 1900
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-4946
Practice Address - Country:US
Practice Address - Phone:630-985-7189
Practice Address - Fax:630-985-7438
Is Sole Proprietor?:No
Enumeration Date:2013-11-01
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051296916183500000X
MO2013028393183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist