Healthcare Provider Details

I. General information

NPI: 1629351077
Provider Name (Legal Business Name): KEDVON PHARMACY SOLUTIONS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2011
Last Update Date: 03/01/2024
Certification Date: 03/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 SOUTH MILWAUKEE AVE.
WHEELING IL
60090
US

IV. Provider business mailing address

56 SO. MILWAUKEE AVE
WHEELING IL
60090
US

V. Phone/Fax

Practice location:
  • Phone: 847-459-0001
  • Fax: 847-947-2972
Mailing address:
  • Phone: 847-459-0001
  • Fax: 847-947-2972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number054-017721
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number054-017721
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number054-07721
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number054-07721
License Number StateIL
# 6
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number054-017721
License Number StateIL

VIII. Authorized Official

Name: MS. VLADLENA KOROL
Title or Position: PRESIDENT
Credential: PHARM.D.
Phone: 847-459-0001