Organization
SHARSHON PHARMACY, INC.
Active
Other names
NORTHSIDE REXALL PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
WALTER SHARSHON RPH (OWNER)
(630) 210-5307
Entity
Organization
Contact information
Practice address
201 N STATE ST, GENESEO, IL 61254-1236
(309) 944-2442
(309) 944-4588
Mailing address
931 W GALENA BLVD, AURORA, IL 60506-3751
(630) 210-5307
(630) 984-5357
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
054011088
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2022550
PK
—
05
—
362755366001
—
IL
Enumeration date
09/21/2006
Last updated
03/16/2017
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