American Drug Stores LLC
Organization Active NPI Community/Retail Pharmacy · Minooka, IL
NPI 1811944366 · NPPES record last updated Jul 19, 2018
Key facts
- NPI
- 1811944366
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 054-015540 (IL)
- Legal business name
- AMERICAN DRUG STORES LLC
- Practice address
- 2051 Ridge Rd
Minooka, IL 60447 - Phone
- (815) 467-1254
- Fax
- (815) 467-1516
- NPI assigned
- May 30, 2006
- Organization subpart
- No
Authorized official
- Name
- Tiffany Eliopulos
- Title
- Assistant Manager, Enrollments
- Phone
- (208) 395-3906
Corporate family (same tax ID) 24
Member of 3
Practitioners 7
-
Jamie Conn, PHARM.D
-
Deborah E Franchi, PHARM. D.
-
Douglas Gossen, R.PH.
-
Shital Manek, PHARM D
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 14D1050512 | Osco Drug #3730 | Certificate of waiver | Feb 5, 2028 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| American Drug Stores LLC |
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 |
|---|---|---|---|---|
| O20100930029690 | IL | DME Supplier - Pharmacy |
1052216835 | Practice locations: Minooka, IL |
National Provider Directory
- Tax ID family
- Osco Drug 956
Locations
2051 Ridge Rd
Minooka, IL 60447
Phone (815) 467-1254
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 054-015540 | IL | Yes |
Addresses
Primary practice location
2051 Ridge Rd
Minooka, IL 60447
Mailing address
250 E Parkcenter Blvd
Mailstop Sec2-B
Boise, ID 83706-3940
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2021827 | Other | PK |
Other names
- OSCO DRUG #3730
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All providers in Minooka, 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 Jul 19, 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.