Church St Pharm Inc

Primary specialty

PharmacyTaxonomy code 333600000X

License

54009433 Issued in IL

Legal business name

CHURCH ST PHARM INC

Practice address

9669 Kenton Ave
Skokie, IL 60076-1266

Phone

(847) 674-5882

Fax

(847) 674-9824

NPI assigned

Oct 7, 2006

Last updated

Oct 28, 2009By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mark Jacobs, RPH

Title

Chief Pharmacist

Phone

(847) 674-5882

Specialties & licenses 2

Addresses

Other identifiers 2

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160179200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1256688000000",
    "number": "1891882080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9669 KENTON AVE",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600761266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9669 KENTON AVE",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600761266",
            "telephone_number": "847-674-5882",
            "fax_number": "847-674-9824"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHURCH ST PHARM INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-07",
        "last_updated": "2009-10-28",
        "status": "A",
        "authorized_official_last_name": "JACOBS",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "CHIEF PHARMACIST",
        "authorized_official_telephone_number": "847-674-5882",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "IL",
            "license": "54009433",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "362405956001",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "1456284",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mark C Chua, NP
• Holly Chuang
• Elizabeth K Chung, M.D.
• Susie Chung, D.D.S.
• Yoo Mi Chung, D.P.T
• Cynthia Ann Ciluffo, L. C. S. W.
• Cimis Fellowship
• Anastasia Cisneros-Frausto, MD
• Alice Cisneros, DPM
• Citadel of Skokie LLC (The Citadel of Skokie)

• Pharmacy in Skokie, IL
• Providers in Skokie, IL by specialty
• Pharmacy in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.