Provider Demographics
NPI:1144573551
Name:SJA PHARMACY, INC
Entity Type:Organization
Organization Name:SJA PHARMACY, INC
Other - Org Name:COMMUNITY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHITAL
Authorized Official - Middle Name:
Authorized Official - Last Name:MANEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-777-7800
Mailing Address - Street 1:9718 S HALSTED ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628-1007
Mailing Address - Country:US
Mailing Address - Phone:773-238-4500
Mailing Address - Fax:773-238-4503
Practice Address - Street 1:9718 S HALSTED ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-1007
Practice Address - Country:US
Practice Address - Phone:773-238-4500
Practice Address - Fax:773-238-4503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-23
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL054-0180243336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1487429OtherNCPDP PROVIDER IDENTIFICATION NUMBER