1629351077 NPI number — KEDVON PHARMACY SOLUTIONS, INC.

Table of content: (NPI 1629351077)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629351077 NPI number — KEDVON PHARMACY SOLUTIONS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KEDVON PHARMACY SOLUTIONS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629351077
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/01/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
56 SO. MILWAUKEE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHEELING
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60090
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-459-0001
Provider Business Mailing Address Fax Number:
847-947-2972

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
56 SOUTH MILWAUKEE AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHEELING
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60090
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-459-0001
Provider Business Practice Location Address Fax Number:
847-947-2972
Provider Enumeration Date:
09/22/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KOROL
Authorized Official First Name:
VLADLENA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
847-459-0001

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , with the licence number: 054-017721 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X , with the licence number: 054-017721 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X , with the licence number: 054-07721 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0004X , with the licence number: 054-07721 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 054-017721 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 054-017721 . This is a "ILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".