Healthcare Provider Details

I. General information

NPI: 1538202692
Provider Name (Legal Business Name): KEDZIE DRUGS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

262 N KEDZIE AVE
CHICAGO IL
60612-1869
US

IV. Provider business mailing address

262 N KEDZIE AVE
CHICAGO IL
60612-1869
US

V. Phone/Fax

Practice location:
  • Phone: 773-826-4400
  • Fax: 773-826-4400
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number StateIL

VIII. Authorized Official

Name: KAMLESH SHAH
Title or Position: PHARMACIST IN CHARGE
Credential:
Phone: 773-826-4400