Provider Demographics
NPI:1124819560
Name:SHAJI, RINU
Entity type:Individual
Prefix:
First Name:RINU
Middle Name:
Last Name:SHAJI
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 OAK TRAILS RD APT 302
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-1281
Mailing Address - Country:US
Mailing Address - Phone:312-768-3457
Mailing Address - Fax:
Practice Address - Street 1:475 EAST ROUTE 173
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:IL
Practice Address - Zip Code:60002-9406
Practice Address - Country:US
Practice Address - Phone:847-838-2148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-15
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.306780183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist