Provider Demographics
NPI:1104234244
Name:KEDVON PHARMACY INTEGRATIONS INC
Entity type:Organization
Organization Name:KEDVON PHARMACY INTEGRATIONS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VLADLENA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOROL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-322-8275
Mailing Address - Street 1:770 S BUFFALO GROVE RD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-3708
Mailing Address - Country:US
Mailing Address - Phone:847-947-2601
Mailing Address - Fax:847-947-2326
Practice Address - Street 1:770 S BUFFALO GROVE RD
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-3708
Practice Address - Country:US
Practice Address - Phone:847-947-2601
Practice Address - Fax:847-947-2326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-31
Last Update Date:2021-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
IL0540186913336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2147190OtherPK
FK4689571OtherDRUG ENFORCEMENT ADMINISTRATION