# SEDA INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** LAKE PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093843351
- **Authorized official:** KEYUR VEKARIA (PRESIDENT)
- **Authorized official phone:** (773) 921-5533

## Contact information

- **Practice address:** 4801 W LAKE ST, CHICAGO, IL 60644-2609
- **Practice address phone:** (773) 921-5533
- **Practice address fax:** (773) 377-8700
- **Mailing address:** 4801 W LAKE ST, CHICAGO, IL 60644-2609
- **Mailing address phone:** (773) 921-5533
- **Mailing address fax:** (773) 377-8700

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | 054.018464 | IL | Yes |

## Other

- **Enumeration date:** 03/01/2007
- **Last updated:** 04/17/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1450662 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |