MEDICARE: KEDZIE DRUGS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0002X	Clinic Pharmacy		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1459305	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER
2	1459305	OTHER		OTHER ID NUMBER

General Provider Information

NPI Number	:	1538202692
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEDZIE DRUGS INC

Provider Business Mailing Address
First Line	:	262 N KEDZIE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-1869
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	262 N KEDZIE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-1869
Country	:	US
Telephone Number	:	773-826-4400
Fax Number	:	773-826-4400

Authorized Official
Title or Position	:	PHARMACIST IN CHARGE
Name	:	KAMLESH SHAH
Credential	:
Telephone Number	:	773-826-4400

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	04/20/2008

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Directions to “KEDZIE DRUGS INC ” Practice Location

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