Roundy'S Supermarkets, Inc
Organization Active NPI Community/Retail Pharmacy · Lombard, IL
NPI 1477098978 · NPPES record last updated Dec 1, 2017
Key facts
- NPI
- 1477098978
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- Legal business name
- ROUNDY'S SUPERMARKETS, INC
- Practice address
- 345 W Roosevelt Rd
Lombard, IL 60148-4219 - Phone
- (630) 629-4475
- NPI assigned
- Dec 20, 2016
- Organization subpart
- No
Authorized official
- Name
- Allison Bredestege
- Title
- Manager of RX Licensing
- Phone
- (513) 762-1019
Other NPIs on the same Medicare enrollment 41
Corporate family (same tax ID) 24
Member of 3
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 14D2166821 | Mariano'S Pharmacy #543 | Certificate of waiver | May 27, 2027 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Roundys Supermarkets Inc |
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 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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… |
| O20180208001235 | IL | DME Supplier - Pharmacy | 5698858470 | Practice locations: Lombard, IL |
National Provider Directory
- Tax ID family
- Mariano'S Pharmacy
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Community/Retail Pharmacy | 3336C0003X | Yes |
Addresses
Primary practice location
345 W Roosevelt Rd
Lombard, IL 60148-4219
Mailing address
PO Box 842772
Boston, MA 02284-2772
Other names
- Mariano's Pharmacy #543
Other providers in Lombard, IL
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- Parisheca Rose
- Mary Colleen Ross-Newman
- Richard Rosseau
- Andrew A Roth
- Brooke Rowe
- Rraf
- Meraly Rubio
- Amy Rudd
- Marshall Ruddy
All providers in Lombard, IL · Community/Retail Pharmacy in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 1, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.