Organization
JOLIET PROFESSIONAL PHARMACY CORP.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHAD J KODIAK (OWNER)
(815) 725-9315
Entity
Organization
Contact information
Practice address
2401 W JEFFERSON ST STE 200, JOLIET, IL 60435-6428
(815) 725-9315
(815) 725-3372
Mailing address
2100 GLENWOOD AVE, JOLIET, IL 60435-5487
(815) 725-9314
(815) 725-7032
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
054-004174
IL
3336C0003X
Community/Retail Pharmacy
Primary
054-004174
IL
Other
Enumeration date
02/13/2007
Last updated
09/20/2022
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