Provider Demographics
NPI:1144336439
Name:SHARSHON PHARMACY INC
Entity type:Organization
Organization Name:SHARSHON PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARSHON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:630-210-5307
Mailing Address - Street 1:120 CHESTNUT ST.
Mailing Address - Street 2:
Mailing Address - City:WENONA
Mailing Address - State:IL
Mailing Address - Zip Code:61377-0602
Mailing Address - Country:US
Mailing Address - Phone:815-853-4342
Mailing Address - Fax:815-853-4348
Practice Address - Street 1:120 N CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:WENONA
Practice Address - State:IL
Practice Address - Zip Code:61377-7527
Practice Address - Country:US
Practice Address - Phone:815-853-4342
Practice Address - Fax:815-853-4348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0540061453336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL362889967001Medicaid
IL054020970OtherPHARMACY