Provider Demographics
NPI:1952757593
Name:PULEIKIS, KENNETH
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:PULEIKIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1224 S WABASH AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-2401
Mailing Address - Country:US
Mailing Address - Phone:312-663-6664
Mailing Address - Fax:312-663-6696
Practice Address - Street 1:1224 S WABASH AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-2401
Practice Address - Country:US
Practice Address - Phone:312-663-6664
Practice Address - Fax:312-663-6696
Is Sole Proprietor?:No
Enumeration Date:2016-05-13
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.290660183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist