Healthcare Provider Details

I. General information

NPI: 1225729270
Provider Name (Legal Business Name): TOMZAK SAENGYOTHINH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: TOMZAKE T SAENGYOTHINH

II. Dates (important events)

Enumeration Date: 05/18/2023
Last Update Date: 09/25/2024
Certification Date: 09/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 W SPRING ST
SOUTH ELGIN IL
60177-2990
US

IV. Provider business mailing address

BUSINESS PRACTICE LOCATION
BARTLETT IL
60103
US

V. Phone/Fax

Practice location:
  • Phone: 847-695-0556
  • Fax:
Mailing address:
  • Phone: 630-372-3310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051303793
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: