Healthcare Provider Details

I. General information

NPI: 1407894645
Provider Name (Legal Business Name): AMERICAN DRUG STORES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 06/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8801 RIDGELAND AVE
OAK LAWN IL
60453
US

IV. Provider business mailing address

250 E PARKCENTER BLVD MAILSTOP SEC2-B
BOISE ID
83706-3940
US

V. Phone/Fax

Practice location:
  • Phone: 708-599-6300
  • Fax: 708-599-6473
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number054-005112
License Number StateIL

VIII. Authorized Official

Name: TIFFANY ELIOPULOS
Title or Position: ENROLLMENT ASSISTANT MANAGER
Credential:
Phone: 208-395-3906