Provider Demographics
NPI:1992815237
Name:SHAH, MAYUR V (PHARMD)
Entity type:Individual
Prefix:
First Name:MAYUR
Middle Name:V
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 1:1001 OGDEN AVE STE LL # 5
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-2865
Mailing Address - Country:US
Mailing Address - Phone:630-667-6860
Mailing Address - Fax:630-929-0852
Practice Address - Street 1:106 N 19TH AVE
Practice Address - Street 2:
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-3755
Practice Address - Country:US
Practice Address - Phone:708-450-0400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist