NPIMap

Organization Active NPI

Sharshon Pharmacy, Inc.

Doing business as Northside Rexall Pharmacy

  • Community/Retail Pharmacy
  • Geneseo, IL
National Provider Identifier
1407954431
Registry record updated Mar 16, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
054011088 Issued in IL
Legal business name
SHARSHON PHARMACY, INC.
Doing business as
Northside Rexall Pharmacy
Practice address
201 N State St
Geneseo, IL 61254-1236
Phone
(309) 944-2442
Fax
(309) 944-4588
NPI assigned
Sep 21, 2006
Last updated
Mar 16, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Walter Sharshon, RPH
Title
Owner
Phone
(630) 210-5307

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X NU
Community/Retail Pharmacy 3336C0003X 054011088 IL Primary

Addresses

Primary practice location

201 N State St
Geneseo, IL 61254-1236

Mailing address

931 W Galena Blvd
Aurora, IL 60506-3751
Phone (630) 210-5307

Other identifiers 2

IdentifierTypeStateIssuer
2022550OtherPK
362755366001MedicaidIL

Other names 1

  • NORTHSIDE REXALL PHARMACY Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Sharshon Pharmacy Inc10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

Locations

201 N State St
Geneseo, IL 61254
Phone (309) 944-2442

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1489622400000",
    "number": "1407954431",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "931 W GALENA BLVD",
            "city": "AURORA",
            "state": "IL",
            "postal_code": "605063751",
            "telephone_number": "630-210-5307",
            "fax_number": "630-984-5357"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 N STATE ST",
            "city": "GENESEO",
            "state": "IL",
            "postal_code": "612541236",
            "telephone_number": "309-944-2442",
            "fax_number": "309-944-4588"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHARSHON PHARMACY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-21",
        "last_updated": "2017-03-16",
        "status": "A",
        "authorized_official_last_name": "SHARSHON",
        "authorized_official_first_name": "WALTER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "630-210-5307",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IL",
            "license": "054011088",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2022550",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "362755366001",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NORTHSIDE REXALL PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Geneseo, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.