Organization
KODO PHARMACY INC
Active
Other names
KODO Pharmacy, Inc.
Organization subpart
No
Provider details
NPI number
Authorized official
CHAD KODIAK (PRESIDENT)
(815) 727-4721
Entity
Organization
Contact information
Practice address
1522 E WASHINGTON ST, JOLIET, IL 60433-1365
(815) 727-4721
(815) 727-7839
Mailing address
1522 E WASHINGTON ST, JOLIET, IL 60433-1365
(815) 727-4721
(815) 727-7839
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
054017695
IL
3336C0004X
Compounding Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1485716
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
06/23/2011
Last updated
09/27/2011
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