Healthcare Provider Details

I. General information

NPI: 1780749119
Provider Name (Legal Business Name): HDK PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 05/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4941 N KEDZIE AVE
CHICAGO IL
60625-5009
US

IV. Provider business mailing address

4941 N KEDZIE AVE
CHICAGO IL
60625-5009
US

V. Phone/Fax

Practice location:
  • Phone: 773-509-9344
  • Fax: 773-509-9344
Mailing address:
  • Phone: 773-509-9344
  • Fax: 773-509-9344

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 Number054013982
License Number StateIL

VIII. Authorized Official

Name: ASHOK OZA
Title or Position: PHCY MGR
Credential:
Phone: 773-509-9344