Provider Demographics
NPI:1427339225
Name:SHAH, TEJAS (PHARM D)
Entity type:Individual
Prefix:DR
First Name:TEJAS
Middle Name:
Last Name:SHAH
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 N NELTNOR BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60185-2315
Mailing Address - Country:US
Mailing Address - Phone:630-293-8951
Mailing Address - Fax:630-293-9488
Practice Address - Street 1:125 N NELTNOR BLVD
Practice Address - Street 2:
Practice Address - City:WEST CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60185-2315
Practice Address - Country:US
Practice Address - Phone:630-293-8951
Practice Address - Fax:630-293-9488
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-07
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.287684183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist