Provider Demographics
NPI:1629351077
Name:KEDVON PHARMACY SOLUTIONS, INC.
Entity Type:Organization
Organization Name:KEDVON PHARMACY SOLUTIONS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:VLADLENA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOROL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:847-459-0001
Mailing Address - Street 1:56 SO. MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090
Mailing Address - Country:US
Mailing Address - Phone:847-459-0001
Mailing Address - Fax:847-947-2972
Practice Address - Street 1:56 SOUTH MILWAUKEE AVE.
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090
Practice Address - Country:US
Practice Address - Phone:847-459-0001
Practice Address - Fax:847-947-2972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-22
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL054-017721332B00000X, 332BX2000X, 3336C0003X
IL054-07721333600000X, 3336C0004X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL054-017721OtherILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION