NPIMap

Organization Active NPI

American Drug Stores LLC

Doing business as Osco Drug #2488

  • Community/Retail Pharmacy
  • Bourbonnais, IL
National Provider Identifier
1114973880
Registry record updated Jun 18, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
054-008105 Issued in IL
Legal business name
AMERICAN DRUG STORES LLC
Doing business as
Osco Drug #2488
Practice address
655 Main St NW
Bourbonnais, IL 60914
Phone
(815) 929-0590
Fax
(815) 929-1433
NPI assigned
May 25, 2006
Last updated
Jun 18, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2018

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

Authorized official

Name
Demond Hawkins
Title
Third Party Manager
Phone
(208) 395-3905

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU
Pharmacy 333600000X NU
Community/Retail Pharmacy 3336C0003X 054-008105 IL Primary

Addresses

Primary practice location

655 Main St NW
Bourbonnais, IL 60914

Mailing address

250 E Parkcenter Blvd
Mailstop Sec2-B
Boise, ID 83706-3940
Phone (208) 395-6200

Other identifiers 1

IdentifierTypeStateIssuer
2018129OtherPK

Other names 1

  • OSCO DRUG #2488 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930051718 IL DME Supplier - PharmacyDME Supplier - Grocery Store 1052216835 Practice locations: Bourbonnais, IL

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D1034337Osco Drug #2488655 Main St N W, Bourbonnais, IL 60914Certificate of waiverNov 30, 2026

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Osco Drug #2488655 Main St, Bourbonnais, IL 60914-2303(815) 929-0590 Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order)|Orthoses: Off-The-Shelf|Ostomy Supplies|Urological Supplies|Surgical Dressings Does not accept assignmentParticipating since Oct 1, 1989

National Provider Directory

National Provider Directory
Tax ID family
Sav on Drugs 3287185 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Member of 3

Organizations this organization is a member of, according to the National Provider Directory.

Locations

655 Main St NW
Bourbonnais, IL 60914
Phone (815) 929-0590

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1148515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529280000000",
    "number": "1114973880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 E PARKCENTER BLVD",
            "address_2": "MAILSTOP SEC2-B",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837063940",
            "telephone_number": "208-395-6200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "655 MAIN ST NW",
            "city": "BOURBONNAIS",
            "state": "IL",
            "postal_code": "60914",
            "telephone_number": "815-929-0590",
            "fax_number": "815-929-1433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMERICAN DRUG STORES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-25",
        "last_updated": "2018-06-18",
        "status": "A",
        "authorized_official_last_name": "HAWKINS",
        "authorized_official_first_name": "DEMOND",
        "authorized_official_title_or_position": "THIRD PARTY MANAGER",
        "authorized_official_telephone_number": "208-395-3905"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IL",
            "license": "054-008105",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2018129",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "OSCO DRUG #2488",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bourbonnais, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.