NPIMap

Organization Active NPI

Roundys Supermarkets Inc

Doing business as Mariano's Pharmacy

  • Community/Retail Pharmacy
  • Buffalo Grove, IL
National Provider Identifier
1740611540
Registry record updated Sep 8, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
054018485 Issued in IL
Legal business name
ROUNDYS SUPERMARKETS INC
Doing business as
Mariano's Pharmacy
Practice address
450 W Half Day Rd
Buffalo Grove, IL 60089-6555
Phone
(847) 634-1130
Fax
(847) 634-8536
NPI assigned
Dec 3, 2013
Last updated
Sep 8, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2014

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

Authorized official

Name
Edward Kitz
Title
Group VP - Legal Risk & Treasury
Phone
(414) 231-5000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 054018485 IL Primary

Addresses

Primary practice location

450 W Half Day Rd
Buffalo Grove, IL 60089-6555

Mailing address

PO Box 473
Ms-2870
Milwaukee, WI 53201-0473
Phone (414) 231-5523

Other identifiers 1

IdentifierTypeStateIssuer
2143421OtherPK

Other names 1

  • MARIANO'S PHARMACY Doing business as

Medicare participation

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

Enrollment records 1

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…

Other NPIs on the same Medicare enrollment 41

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

View all 41

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
14D2036131Mariano's Pharmacy #8521450 Half Day Rd, Buffalo Grove, IL 60089Certificate of waiverJan 31, 2028

National Provider Directory

National Provider Directory

Member of 2

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

Locations

450 W Half Day Rd
Buffalo Grove, IL 60089
Phone (847) 634-1130

NPI Registry JSON

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

{
    "created_epoch": "1386028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1410134400000",
    "number": "1740611540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 473",
            "address_2": "MS-2870",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532010473",
            "telephone_number": "414-231-5523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 W HALF DAY RD",
            "city": "BUFFALO GROVE",
            "state": "IL",
            "postal_code": "600896555",
            "telephone_number": "847-634-1130",
            "fax_number": "847-634-8536"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROUNDYS SUPERMARKETS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-03",
        "last_updated": "2014-09-08",
        "status": "A",
        "authorized_official_last_name": "KITZ",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_title_or_position": "GROUP VP - LEGAL RISK & TREASURY",
        "authorized_official_telephone_number": "414-231-5000"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IL",
            "license": "054018485",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2143421",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MARIANO'S PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Buffalo Grove, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2014; 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.