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General NPI Number Information
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NPI Number | 1396098034
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Entity Type | Organization
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Legal Business Name | SJA PHARMACY, INC
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Dates
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Enumeration Date | 10/18/2012
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Last Update Date | 10/18/2012
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Provider Practice Location Address
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Address Line | 9718 SOUTH HALSTED STREET
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City | CHICAGO
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State | IL
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Zip | 60628-1007
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Country | US
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Telephone | 773-238-4500
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Fax | 773-238-4503
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Provider Business Mailing Address
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Address Line | 9718 S HALSTED ST
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City | CHICAGO
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State | IL
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Zip | 60628-1007
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Country | US
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Telephone | 773-238-4500
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SHITAL MANEK
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Credential | PHARM. D
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Telephone | 630-777-7800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 054018024
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License Number State | IL
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