Healthcare Provider Details

I. General information

NPI: 1861489353
Provider Name (Legal Business Name): KEDVON PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 02/20/2021
Certification Date: 02/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62 S MILWAUKEE AVE
WHEELING IL
60090-3108
US

IV. Provider business mailing address

62 S MILWAUKEE AVE
WHEELING IL
60090-3108
US

V. Phone/Fax

Practice location:
  • Phone: 773-338-7171
  • Fax: 773-338-7272
Mailing address:
  • Phone: 773-338-7171
  • Fax: 773-338-7272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: VLADLENA KOROL
Title or Position: OWNER
Credential: PHARMD
Phone: 773-338-7171