Provider Demographics
NPI:1225729270
Name:SAENGYOTHINH, TOMZAK
Entity Type:Individual
Prefix:
First Name:TOMZAK
Middle Name:
Last Name:SAENGYOTHINH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:TOMZAKE
Other - Middle Name:
Other - Last Name:SAENGYOTHINH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1201 W SPRING ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60177-2990
Mailing Address - Country:US
Mailing Address - Phone:847-695-0556
Mailing Address - Fax:
Practice Address - Street 1:1201 W SPRING ST
Practice Address - Street 2:
Practice Address - City:SOUTH ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60177-2990
Practice Address - Country:US
Practice Address - Phone:847-695-0556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051303793183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist