American Drug Stores LLC
Organization Active NPI Community/Retail Pharmacy · Sycamore, IL
NPI 1689845075 · NPPES record last updated Jun 28, 2018
Key facts
- NPI
- 1689845075
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 054-016424 (IL)
- Legal business name
- AMERICAN DRUG STORES LLC
- Practice address
- 220 W Peace Rd
Sycamore, IL 60178 - Phone
- (815) 895-9435
- Fax
- (815) 895-7476
- NPI assigned
- Mar 13, 2008
- Organization subpart
- No
Authorized official
- Name
- Tiffany Eliopulos
- Title
- Enrollment Assistant Manager
- Phone
- (208) 395-3906
Corporate family (same tax ID) 24
Member of 3
Practitioners 3
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 14D1082214 | Osco Drug #3381 | Certificate of waiver | Apr 2, 2028 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Osco Drug #3381 |
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 assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930017316 | IL | DME Supplier - Pharmacy |
1052216835 | Practice locations: Sycamore, IL |
National Provider Directory
- Tax ID family
- Osco Drug 956
Locations
220 W Peace Rd
Sycamore, IL 60178
Phone (815) 895-9435
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Community/Retail Pharmacy | 3336C0003X | 054-016424 | IL | Yes |
Addresses
Primary practice location
220 W Peace Rd
Sycamore, IL 60178
Mailing address
250 E Parkcenter Blvd
Mailstop Sec2-B
Boise, ID 83706-3940
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2023660 | Other | PK |
Other names
- OSCO DRUG #3381
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All providers in Sycamore, 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 Jun 28, 2018. 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.