Kodo Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

054017695 Issued in IL

Legal business name

KODO PHARMACY INC

Doing business as

KODO Pharmacy, Inc.

Practice address

1522 E Washington St
Joliet, IL 60433-1365

Phone

(815) 727-4721

Fax

(815) 727-7839

NPI assigned

Jun 23, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Chad Kodiak

Title

President

Phone

(815) 727-4721

Specialties & licenses 5

Addresses

Other identifiers 1

Other names 1

• KODO Pharmacy, Inc. Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1308787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1317081600000",
    "number": "1215223755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1522 E WASHINGTON ST",
            "city": "JOLIET",
            "state": "IL",
            "postal_code": "604331365",
            "telephone_number": "815-727-4721",
            "fax_number": "815-727-7839"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1522 E WASHINGTON ST",
            "city": "JOLIET",
            "state": "IL",
            "postal_code": "604331365",
            "telephone_number": "815-727-4721",
            "fax_number": "815-727-7839"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KODO PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-23",
        "last_updated": "2011-09-27",
        "status": "A",
        "authorized_official_last_name": "KODIAK",
        "authorized_official_first_name": "CHAD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "815-727-4721"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IL",
            "license": "054017695",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "1485716",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KODO Pharmacy, Inc.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Stanley D Knight, MD
• Martha T Kochno, O.D.
• Chad Kodiak, PHARMD, RPH
• Kodo Care, Inc.
• Kodo Care, Inc.
• Kara Koestner
• Kirsten E Kokalj
• Julie Ann Kokenes, LCSW
• Kimberly A Kollwelter, PT
• Katherine Koncar, PHARMD

• Community/Retail Pharmacy in Joliet, IL
• Providers in Joliet, IL by specialty
• Community/Retail Pharmacy in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.