St Jude Pharmacy, Inc.

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

ST JUDE PHARMACY, INC.

Practice address

301 Madison St Ste 114
Joliet, IL 60435-6549

Phone

(815) 900-9000

Fax

(815) 900-5500

NPI assigned

Feb 6, 2019

Organization subpart

No

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

Authorized official

Name

Mohammed J Alahmed, RPH.

Title

Pharmacist in Charge

Phone

(815) 900-9000

Specialties & licenses 5

Addresses

Other identifiers 2

Other names 1

• ST. JUDE PHARMACY Doing business as

Medicare fee-for-service enrollment

Enrolled in IL3 enrollments

Enrollment records 3

Tax ID family

St Jude Pharmacy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• St Jude Pharmacy, Inc.

  • Long Term Care Pharmacy
  • Joliet, IL
  • NPI 1861297749
  NPD tax ID

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

{
    "created_epoch": "1549411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1555027200000",
    "number": "1790240489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 MADISON ST STE 114",
            "city": "JOLIET",
            "state": "IL",
            "postal_code": "604356549",
            "telephone_number": "815-900-9000",
            "fax_number": "815-900-5500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 MADISON ST STE 114",
            "city": "JOLIET",
            "state": "IL",
            "postal_code": "604356549",
            "telephone_number": "815-900-9000",
            "fax_number": "815-900-5500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST JUDE PHARMACY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-06",
        "last_updated": "2019-04-12",
        "status": "A",
        "authorized_official_last_name": "ALAHMED",
        "authorized_official_first_name": "MOHAMMED",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PHARMACIST IN CHARGE",
        "authorized_official_telephone_number": "815-900-9000",
        "authorized_official_credential": "RPH."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "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
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ILLINOIS DEPARTMENT IF FINANCIAL AND PROFESSIONAL REGULATION PHARMACY LICENSE",
            "identifier": "054021109",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IDFPR ILLINOIC CONTROLLED PHARMACY LICENSE",
            "identifier": "320012950",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ST. JUDE PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "ST. JUDE PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Karen Ann Stachowicz, M.A., CCC-A
• Timothy Stacy, DNP
• Jennifer J Stammich, OD

• Community/Retail Pharmacy in Joliet, IL
• Providers in Joliet, IL by specialty
• Community/Retail Pharmacy in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2019; 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.

Verify at the official NPI Registry.