Provider Demographics
NPI:1639115439
Name:PEE DEE KAY INC
Entity Type:Organization
Organization Name:PEE DEE KAY INC
Other - Org Name:CHICAGO KEDZIE DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:RONAK
Authorized Official - Middle Name:
Authorized Official - Last Name:MANER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:773-486-2684
Mailing Address - Street 1:4054 W NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60639-5223
Mailing Address - Country:US
Mailing Address - Phone:773-486-2684
Mailing Address - Fax:773-486-2742
Practice Address - Street 1:4054 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60639-5223
Practice Address - Country:US
Practice Address - Phone:773-486-2684
Practice Address - Fax:773-486-2742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0002X
IL540139023336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2024710OtherPK
IL=========001Medicaid
IL=========001Medicaid