OrganizationActive
Fullerton Kedzie Professional Pharmacy
NPI 1083005078 · Community/Retail Pharmacy · Chicago, IL
Fullerton Kedzie Professional Pharmacy is a Community/Retail Pharmacy organization in Chicago, IL (NPI 1083005078).
Provider details
- NPI number
- 1083005078
- Entity type
- Organization
- Primary specialty
- Community/Retail PharmacySuppliers
- Organization subpart
- No
- Authorized official
- Ettore Boggetto, Pharmacist-In-Charge(773) 278-6604
- License
- 054-007134 (IL)
Specialties & taxonomies
Suppliers
Profile Score
Established profile(74/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
11 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
3153 W Fullerton Ave
Chicago, IL 60647-2809
Phone: (773) 278-6604
Fax: (773) 395-4633
Street-level locationGet directions
Mailing address
3153 W Fullerton Ave
Chicago, IL 60647-2809
Registry dates
- Enumerated
- 2015-02-11
- Last updated
- 2015-02-11
Frequently asked questions
- What is Fullerton Kedzie Professional Pharmacy's NPI number?
- Fullerton Kedzie Professional Pharmacy's National Provider Identifier (NPI) is 1083005078, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Fullerton Kedzie Professional Pharmacy?
- Fullerton Kedzie Professional Pharmacy is classified in the NPPES registry as Community/Retail Pharmacy (Suppliers).
- Where is Fullerton Kedzie Professional Pharmacy located?
- Fullerton Kedzie Professional Pharmacy's practice location on file with NPPES is 3153 W Fullerton Ave, Chicago, IL 60647-2809.
- What is Fullerton Kedzie Professional Pharmacy's phone number?
- The practice phone number listed in the NPPES registry for Fullerton Kedzie Professional Pharmacy is (773) 278-6604.
- Who is the authorized official for Fullerton Kedzie Professional Pharmacy?
- The authorized official listed on Fullerton Kedzie Professional Pharmacy's NPPES record is Ettore Boggetto, Pharmacist-In-Charge. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Fullerton Kedzie Professional Pharmacy's NPI active?
- Yes — Fullerton Kedzie Professional Pharmacy's NPI (1083005078) is active in the NPPES registry as of the last update on 2015-02-11.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.