NPIMap

Organization Active NPI

American Drug Stores LLC

Doing business as Osco Drug #2504

  • Community/Retail Pharmacy
  • Merrionette Park, IL
National Provider Identifier
1609293539
Registry record updated Jul 10, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
054-018664 Issued in IL
Legal business name
AMERICAN DRUG STORES LLC
Doing business as
Osco Drug #2504
Practice address
3243 W 115TH St
Merrionette Park, IL 60803
Phone
(708) 389-9021
Fax
(708) 389-9261
NPI assigned
Mar 28, 2014
Last updated
Jul 10, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2018

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

Authorized official

Name
Tiffany Eliopulos
Title
Assistant Manager, Enrollments
Phone
(208) 395-3906

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU
Pharmacy 333600000X NU
Community/Retail Pharmacy 3336C0003X 054-018664 IL Primary

Addresses

Primary practice location

3243 W 115TH St
Merrionette Park, IL 60803

Mailing address

250 E Parkcenter Blvd
Mailstop Sec2-B
Boise, ID 83706-3940
Phone (847) 916-4463

Other identifiers 1

IdentifierTypeStateIssuer
2145161OtherPK

Other names 1

  • OSCO DRUG #2504 Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140903000855 IL DME Supplier - PharmacyDME Supplier - Grocery Store 1052216835 Practice locations: Merrionette Park, 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
14D2080319Osco Drug #25043243 W 115TH St, Merrionette Park, IL 60803Certificate of waiverJul 2, 2028

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Osco Drug #25043243 W 115TH St, Merrionette Park, IL 60803-4555(708) 389-9021 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
Osco Drug 989185 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

3243 W 115th St
Merrionette Park, IL 60803
Phone (708) 389-9021

NPI Registry JSON

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

{
    "created_epoch": "1395964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531180800000",
    "number": "1609293539",
    "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": "847-916-4463",
            "fax_number": "847-916-4736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3243 W 115TH ST",
            "city": "MERRIONETTE PARK",
            "state": "IL",
            "postal_code": "60803",
            "telephone_number": "708-389-9021",
            "fax_number": "708-389-9261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMERICAN DRUG STORES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-28",
        "last_updated": "2018-07-10",
        "status": "A",
        "authorized_official_last_name": "ELIOPULOS",
        "authorized_official_first_name": "TIFFANY",
        "authorized_official_title_or_position": "ASSISTANT MANAGER, ENROLLMENTS",
        "authorized_official_telephone_number": "208-395-3906"
    },
    "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": "054-018664",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2145161",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "OSCO DRUG #2504",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Merrionette Park, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 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.