Provider Demographics
NPI:1770665317
Name:SINAI COMMUNITY PHARMACY INC
Entity Type:Organization
Organization Name:SINAI COMMUNITY PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SYSTEM DIRECTOR OF AMB CARE PHARM
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:YU
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:773-257-2486
Mailing Address - Street 1:2750 W 15TH PL STE C1120
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-1704
Mailing Address - Country:US
Mailing Address - Phone:773-257-6900
Mailing Address - Fax:773-257-4783
Practice Address - Street 1:2750 W 15TH PL STE C1120
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-1704
Practice Address - Country:US
Practice Address - Phone:773-257-6900
Practice Address - Fax:773-257-4783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
IL054.0112483336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2019775OtherPK
2019775OtherPK
2019775OtherPK