Organization
SEDA INC
Active
Other names
LAKE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
KEYUR VEKARIA (PRESIDENT)
(773) 921-5533
Entity
Organization
Contact information
Practice address
4801 W LAKE ST, CHICAGO, IL 60644-2609
(773) 921-5533
(773) 377-8700
Mailing address
4801 W LAKE ST, CHICAGO, IL 60644-2609
(773) 921-5533
(773) 377-8700
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
054.018464
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1450662
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
03/01/2007
Last updated
04/17/2014
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