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General NPI Number Information
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NPI Number | 1144362567
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Entity Type | Organization
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Legal Business Name | JOLIET PROFESSIONAL PHARMACY CORP.
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 09/20/2022
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Provider Practice Location Address
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Address Line | 2401 W JEFFERSON ST STE 200
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City | JOLIET
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State | IL
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Zip | 60435-6428
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Country | US
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Telephone | 815-725-9315
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Fax | 815-725-3372
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Provider Business Mailing Address
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Address Line | 2100 GLENWOOD AVE
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City | JOLIET
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State | IL
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Zip | 60435-5487
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Country | US
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Telephone | 815-725-9314
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Fax | 815-725-7032
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHAD J KODIAK
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Credential |
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Telephone | 815-725-9315
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 054-004174
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 054-004174
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License Number State | IL
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