Provider Demographics
NPI:1558525782
Name:MUKHOPADHYAY, SAMBHU NATH (RPH)
Entity Type:Individual
Prefix:MR
First Name:SAMBHU
Middle Name:NATH
Last Name:MUKHOPADHYAY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2426 S 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH RIVERSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60546-1206
Mailing Address - Country:US
Mailing Address - Phone:708-442-0644
Mailing Address - Fax:
Practice Address - Street 1:5TH AVENUE & ROOSEVELT ROAD
Practice Address - Street 2:BUILDING 37 NW CMOPP
Practice Address - City:HINES
Practice Address - State:IL
Practice Address - Zip Code:60141
Practice Address - Country:US
Practice Address - Phone:708-786-7553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.0339581835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy