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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	PH731	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	2904945	OTHER	OTHER ID NUMBER-COMMERCIAL NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	2904945	OTHER	OTHER ID NUMBER

General Provider Information

NPI Number	:	1073569620
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERICAN DRUG STORES LLC

Provider Business Mailing Address
First Line	:	4120 S RAINBOW BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-3106
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4120 S RAINBOW BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-3106
Country	:	US
Telephone Number	:	702-362-1951
Fax Number	:	702-362-7138

Authorized Official
Title or Position	:	NEW STORE ENROLLMENTS
Name	:	LORENZO TORRES
Credential	:
Telephone Number	:	847-916-4463

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	11/21/2007

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Directions to “AMERICAN DRUG STORES LLC ” Practice Location

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