Healthcare Provider Details

I. General information

NPI: 1639115439
Provider Name (Legal Business Name): PEE DEE KAY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 03/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4054 W NORTH AVE
CHICAGO IL
60639-5223
US

IV. Provider business mailing address

4054 W NORTH AVE
CHICAGO IL
60639-5223
US

V. Phone/Fax

Practice location:
  • Phone: 773-486-2684
  • Fax: 773-486-2742
Mailing address:
  • Phone: 773-486-2684
  • Fax: 773-486-2742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number54013902
License Number StateIL

VIII. Authorized Official

Name: RONAK MANER
Title or Position: PHARMACIST
Credential: RPH
Phone: 773-486-2684