# KODO PHARMACY INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** KODO Pharmacy, Inc.
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215223755
- **Authorized official:** CHAD KODIAK (PRESIDENT)
- **Authorized official phone:** (815) 727-4721

## Contact information

- **Practice address:** 1522 E WASHINGTON ST, JOLIET, IL 60433-1365
- **Practice address phone:** (815) 727-4721
- **Practice address fax:** (815) 727-7839
- **Mailing address:** 1522 E WASHINGTON ST, JOLIET, IL 60433-1365
- **Mailing address phone:** (815) 727-4721
- **Mailing address fax:** (815) 727-7839

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 054017695 | IL | Yes |
| 3336C0004X | Compounding Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | — |
| 3336S0011X | Specialty Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 06/23/2011
- **Last updated:** 09/27/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1485716 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |