Basic Information
| Provider Information | |||||||||
| NPI: | 1679829576 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PACE | ||||||||
| FirstName: | SHANNON | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHARM.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4560 N OPAL AVE | ||||||||
| Address2: | |||||||||
| City: | NORRIDGE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 607064421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7735877054 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5000 S 5TH AVE | ||||||||
| Address2: | |||||||||
| City: | HINES | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601413030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7082022488 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2012 | ||||||||
| LastUpdateDate: | 07/28/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 051295846 | IL | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.