Active NPI
Kingston Healthcare Consulting, LLC
- Community/Retail Pharmacy
- Waukegan, IL
National Provider Identifier
1669139648
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- Legal business name
- KINGSTON HEALTHCARE CONSULTING, LLC
- Practice address
- 2702 Grand Ave
Waukegan, IL 60085-2407 - Phone
- (224) 441-3008
- Fax
- (224) 441-3016
- NPI assigned
- Nov 24, 2021
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Averill Gordon, PHARM.D.
- Title
- Owner
- Phone
- (904) 477-3853
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | Primary |
Addresses
Primary practice location
2702 Grand Ave
Waukegan, IL 60085-2407
Mailing address
1282 Chesterfield LN
Grayslake, IL 60030-3797
Phone (904) 477-3853
Other names 1
- Tu Pharmacy
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20220414000735 | IL | Part B Supplier - Pharmacy | 6608262902 | Practice locations: Waukegan, IL |
National Provider Directory
National Provider Directory- Tax ID family
- Kingston Healthcare Consulting LLC
Other organizations with this tax ID 2
Organizations that report the same tax identification number in the National Provider Directory.
-
- Long Term Care Pharmacy
- Waukegan, IL
- NPI 1255047825
-
- Pharmacy
- Waukegan, IL
- NPI 1760141956
Locations
2702 Grand Ave
Waukegan, IL 60085
Phone (224) 441-3008
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1637712000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1706832000000",
"number": "1669139648",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1282 CHESTERFIELD LN",
"city": "GRAYSLAKE",
"state": "IL",
"postal_code": "600303797",
"telephone_number": "904-477-3853"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2702 GRAND AVE",
"city": "WAUKEGAN",
"state": "IL",
"postal_code": "600852407",
"telephone_number": "224-441-3008",
"fax_number": "224-441-3016"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "KINGSTON HEALTHCARE CONSULTING, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2021-11-24",
"last_updated": "2024-02-02",
"certification_date": "2024-02-02",
"status": "A",
"authorized_official_last_name": "GORDON",
"authorized_official_first_name": "AVERILL",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "904-477-3853",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "PHARM.D."
},
"taxonomies": [
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": null,
"license": null,
"primary": false
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Tu Pharmacy",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Waukegan, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.