Provider Demographics
NPI:1063205110
Name:SHIBA, LAYLA BATO
Entity type:Individual
Prefix:MISS
First Name:LAYLA
Middle Name:BATO
Last Name:SHIBA
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:LAYLA
Other - Middle Name:BATO
Other - Last Name:SHIBA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5435 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-2011
Mailing Address - Country:US
Mailing Address - Phone:224-770-0100
Mailing Address - Fax:
Practice Address - Street 1:5435 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-2011
Practice Address - Country:US
Practice Address - Phone:224-770-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-22
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL049212852183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician