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Roundys Supermarkets Inc

Organization Active NPI Community/Retail Pharmacy · Evergreen Park, IL

NPI 1366840662 · NPPES record last updated Jul 11, 2016

Key facts

NPI
1366840662
Entity type
Organization (NPI type 2)
Primary specialty
Community/Retail Pharmacy 3336C0003X
Legal business name
ROUNDYS SUPERMARKETS INC
Practice address
2559 W 95TH St
Evergreen Park, IL 60805
Phone
(708) 422-2056
NPI assigned
Dec 18, 2014
Organization subpart
No

Authorized official

Name
William Dowling
Title
Vice President
Phone
(414) 231-5000

Other NPIs on the same Medicare enrollment 41

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 41

Corporate family (same tax ID) 23

Organizations that report the same tax identification number in the National Provider Directory.

Member of 3

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

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Laboratory certificates & supplier records

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

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Mariano'S Pharmacy #8530
2559W 95TH St, Evergreen Park, IL 60805-2809 · (708) 422-2056		 Immunosuppressive Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Commodes, Urinals, Bedpans|Blood Glucose Monitors/Supplies (Non-Mail Order)|Canes and/or Crutches|Walkers|Ostomy Supplies|Urological Supplies|Enteral Nutrients|Enteral Equipment and/or Supplies|Nebulizer Equipment a… Accepts assignment
Participating since Dec 18, 2023

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in IL

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20110329000044 IL Part B Supplier - Mass Immunization (Roster Biller Only) 5698858470 41 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Skokie, IL; Harwood Heights, IL; Hoffman Estates, IL; Lake Zurich, IL; Lombard, IL; Gurnee, IL; Naperville, IL; Northbrook, IL…
O20150410000883 IL DME Supplier - Pharmacy 5698858470 Practice locations: Evergreen Park, IL

National Provider Directory

Tax ID family
Mariano'S Pharmacy (103 organizations share this tax ID)

Locations

2559 W 95th St
Evergreen Park, IL 60805
Phone (708) 422-2056

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X Yes

Addresses

Primary practice location

2559 W 95TH St
Evergreen Park, IL 60805

Mailing address

PO Box 473
Ms-2870
Milwaukee, WI 53201-0473
Phone (414) 231-5000

Other names

  • MARIANO'S PHARMACY #8530 Doing business as

Other providers in Evergreen Park, IL

All providers in Evergreen Park, IL · Community/Retail Pharmacy in Illinois

Sources for this page

Verify at the official NPI Registry.