American Drug Stores LLC
Organization Active NPI Community/Retail Pharmacy · Moline, IL
NPI 1962458596 · NPPES record last updated Jul 20, 2018
Key facts
- NPI
- 1962458596
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 054-005378 (IL)
- Legal business name
- AMERICAN DRUG STORES LLC
- Practice address
- 2014 1St Street a
Moline, IL 61265 - Phone
- (309) 797-9320
- Fax
- (309) 797-0199
- NPI assigned
- May 25, 2006
- Organization subpart
- No
Authorized official
- Name
- Tiffany Eliopulos
- Title
- Assistant Manager, Enrollments
- Phone
- (208) 395-3906
Corporate family (same tax ID) 16
Member of 3
Practitioners 5
-
Deanna Brumbaugh, CPHT, RN
-
Marty Jon Milefchik, RPH
-
Brian James Roseman, PHARM.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930064218 | IL | DME Supplier - Pharmacy | 1052216835 | Practice locations: Moline, IL |
National Provider Directory
- Tax ID family
- Osco Drug 956
Locations
2014 1st Street a
Moline, IL 61265
Phone (309) 797-9286
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 054-005378 | IL | Yes |
Addresses
Primary practice location
2014 1St Street a
Moline, IL 61265
Mailing address
250 E Parkcenter Blvd
Mailstop Sec2-B
Boise, ID 83706-3940
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2022689 | Other | PK |
Other names
- OSCO DRUG #0122
Other providers in Moline, IL
- Alternative Energy Builders
- Alternatives for the Older Adult, Inc
- America'S Best Contacts & Eyeglasses
- American Current Care of Illinois PC
- American Current Care of Illinois PC
- American Prosthetics & Orthotics, Inc.
- Amicare Pharmacy, Inc
- Jean Anciaux
- Cynthia L Anderson-Dobroski
- Maria Anderson-Dooley
All providers in Moline, 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 20, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.