Provider Demographics
NPI:1124038666
Name:SNC INC.
Entity Type:Organization
Organization Name:SNC INC.
Other - Org Name:FREDRICKSON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SHANTILAL
Authorized Official - Middle Name:T
Authorized Official - Last Name:CHHADWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-253-7110
Mailing Address - Street 1:2121 ONEIDA ST
Mailing Address - Street 2:SUITE # 101
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-6544
Mailing Address - Country:US
Mailing Address - Phone:815-725-0991
Mailing Address - Fax:
Practice Address - Street 1:2121 ONEIDA ST
Practice Address - Street 2:SUITE # 101
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-6544
Practice Address - Country:US
Practice Address - Phone:815-725-0991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid