MEDICARE: AMERICAN DRUG STORES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336C0003X	Community/Retail Pharmacy	054-014704	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2017704	OTHER		PK

General Provider Information

NPI Number	:	1013963669
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERICAN DRUG STORES LLC

Provider Business Mailing Address
First Line	:	250 E PARKCENTER BLVD
Second Line	:	MAILSTOP SEC2-B
City	:	BOISE
State	:	ID
Zip	:	83706-3940
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1220 S ASHLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608
Country	:	US
Telephone Number	:	312-733-2837
Fax Number	:	312-733-7431

Authorized Official
Title or Position	:	ENROLLMENT ASSISTANT MANAGER
Name	:	TIFFANY ELIOPULOS
Credential	:
Telephone Number	:	208-395-3906

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	06/28/2018

Similar Medicare Providers

1497384416 — SAFFET GULERYUZ
Practice Location Address:

1500 S FAIRFIELD AVE
CHICAGO, IL
60608-1782

Practice Phone: 773-542-2000
Practice Fax:

1265169254 — INDUJA RAJENDRAN MD
Practice Location Address:

1500 S FAIRFIELD AVE
CHICAGO, IL
60608-1782

Practice Phone: 773-542-2000
Practice Fax:

1518531946 — NICOLE KATHRYN ASHER MD
Practice Location Address:

1500 S FAIRFIELD AVE
CHICAGO, IL
60608-1782

Practice Phone: 321-352-0994
Practice Fax:

1609730175 — ARIEL ZIEMBA
Practice Location Address:

1622 S BLUE ISLAND AVE STE 1
CHICAGO, IL
60608-2238

Practice Phone: 312-584-0559
Practice Fax:

1720976897 — UH JIN LEE
Practice Location Address:

1500 S FAIRFIELD AVE
CHICAGO, IL
60608-1782

Practice Phone: 773-542-2000
Practice Fax:

1689538738 — SINAI COMMUNITY PHARMACY INC
Practice Location Address:

2750 W 15TH PL # C1120
CHICAGO, IL
60608-1704

Practice Phone: 773-257-6900
Practice Fax: 773-257-4783

1447112297 — SUKOON BEHAVIORAL PLLC
Practice Location Address:

917 W 18TH ST STE 316
CHICAGO, IL
60608-2400

Practice Phone: 618-713-5547
Practice Fax:

Directions to “AMERICAN DRUG STORES LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.