Provider Demographics
NPI:1922416197
Name:KODO CARE, INC.
Entity Type:Organization
Organization Name:KODO CARE, INC.
Other - Org Name:KODO CARE, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARM D/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:KODIAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-727-4722
Mailing Address - Street 1:2401 W JEFFERSON ST STE 100
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-7830
Mailing Address - Country:US
Mailing Address - Phone:815-727-4722
Mailing Address - Fax:815-727-4731
Practice Address - Street 1:2401 W JEFFERSON ST STE 100
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-6428
Practice Address - Country:US
Practice Address - Phone:815-727-4722
Practice Address - Fax:815-727-4731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-31
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
291U00000X, 332B00000X, 333600000X, 3336C0003X, 3336C0004X, 3336S0011X
IL054-0184573336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No291U00000XLaboratoriesClinical Medical Laboratory
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2146567OtherPK