Provider Demographics
NPI:1366537094
Name:MEDSHOP PHARMACY LLC
Entity type:Organization
Organization Name:MEDSHOP PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FATIMA
Authorized Official - Middle Name:PARISA
Authorized Official - Last Name:ZAHRAEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-961-8500
Mailing Address - Street 1:507 FAIRWAY DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-4051
Mailing Address - Country:US
Mailing Address - Phone:630-961-8500
Mailing Address - Fax:630-961-6105
Practice Address - Street 1:507 FAIRWAY DR
Practice Address - Street 2:SUITE 103
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-4051
Practice Address - Country:US
Practice Address - Phone:630-961-8500
Practice Address - Fax:630-961-6105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL51-038694183500000X
IL051038694332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL=========001Medicaid