NPIMap

Organization Active NPI

Roundys Supermarkets Inc

Doing business as Mariano's Pharmacy

  • Community/Retail Pharmacy
  • Chicago, IL
National Provider Identifier
1942555453
Registry record updated May 22, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
054018021 Issued in IL
Legal business name
ROUNDYS SUPERMARKETS INC
Doing business as
Mariano's Pharmacy
Practice address
5353 N Elston Ave
Chicago, IL 60630-1610
Phone
(773) 481-6936
Fax
(773) 481-6962
NPI assigned
Jul 20, 2012
Last updated
May 22, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 22, 2013

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

Authorized official

Name
Edward Kitz
Title
GVP - Legal Risk Treasury
Phone
(414) 231-5000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 054018021 IL Primary

Addresses

Primary practice location

5353 N Elston Ave
Chicago, IL 60630-1610

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
2136114OtherPK

Other names 1

  • MARIANO'S PHARMACY Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL2 enrollments

Enrollment records 2

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…
O20130510000131 IL DME Supplier - PharmacyDME Supplier - Grocery Store 5698858470 Practice locations: Chicago, 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
14D2036100Mariano's Pharmacy #85075353 N Elston, Chicago, IL 60630Certificate of waiverJan 31, 2028

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Mariano's Pharmacy #85075353N Elston Ave, Chicago, IL 60630-1610(773) 481-6936 Immunosuppressive Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Commodes, Urinals, Bedpans|Blood Glucose Monitors/Supplies (Non-Mail Order)|Canes and/or Crutches|Walkers|Ostomy Supplies|Urological Supplies|Enteral Nutrients|Enteral Equipment and/or Supplies|Nebulizer Equipment a… Accepts assignmentParticipating since Dec 18, 2023

National Provider Directory

National Provider Directory
Tax ID family
Roundys Supermarkets Inc103 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 15

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 15

Member of 3

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

Locations

5353 N Elston Ave
Chicago, IL 60630
Phone (773) 459-4031

NPI Registry JSON

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

{
    "created_epoch": "1342742400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1369180800000",
    "number": "1942555453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 473",
            "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": "5353 N ELSTON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606301610",
            "telephone_number": "773-481-6936",
            "fax_number": "773-481-6962"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROUNDYS SUPERMARKETS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-20",
        "last_updated": "2013-05-22",
        "status": "A",
        "authorized_official_last_name": "KITZ",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_title_or_position": "GVP - LEGAL RISK TREASURY",
        "authorized_official_telephone_number": "414-231-5000"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IL",
            "license": "054018021",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2136114",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MARIANO'S PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2013; 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.