Provider Demographics
NPI:1477320489
Name:KUNAC, SANJA
Entity Type:Individual
Prefix:
First Name:SANJA
Middle Name:
Last Name:KUNAC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8725 W SUMMERDALE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60656-2331
Mailing Address - Country:US
Mailing Address - Phone:773-614-3924
Mailing Address - Fax:
Practice Address - Street 1:4820 N CUMBERLAND AVE
Practice Address - Street 2:
Practice Address - City:NORRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60706-2914
Practice Address - Country:US
Practice Address - Phone:708-583-2133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-08
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051306046183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist