MEDICARE: PEE DEE KAY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0002X	Clinic Pharmacy
3	3336C0003X	Community/Retail Pharmacy	54013902	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2024710	OTHER		PK

General Provider Information

NPI Number	:	1639115439
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEE DEE KAY INC

Provider Business Mailing Address
First Line	:	4054 W NORTH AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60639-5223
Country	:	US
Telephone Number	:	773-486-2684
Fax Number	:	773-486-2742

Provider Business Practice Location Address
First Line	:	4054 W NORTH AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60639-5223
Country	:	US
Telephone Number	:	773-486-2684
Fax Number	:	773-486-2742

Authorized Official
Title or Position	:	PHARMACIST
Name	:	RONAK MANER
Credential	:	RPH
Telephone Number	:	773-486-2684

Provider Enumeration Date	:	06/21/2006
Last Update Date	:	03/19/2014

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Directions to “PEE DEE KAY INC ” Practice Location

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