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NPI Code Detail

MEDICARE: AMERICAN DRUG STORES LLC

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
1332B00000XDurable Medical Equipment & Medical Supplies
2333600000XPharmacy
33336C0003XCommunity/Retail Pharmacy054008625IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11450838OTHERNCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number : 1225085772
Entity Type Code : Organization
Provider Name (Legal Business Name) : AMERICAN DRUG STORES LLC
Provider Business Mailing Address
First Line : 3030 CULLERTON ST
Second Line :
City : FRANKLIN PARK
State : IL
Zip : 60131-2205
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6057 S WESTERN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60636-2019
Country : US
Telephone Number : 773-925-9749
Fax Number : 773-925-0196
Authorized Official
Title or Position : ASST MANAGER PLAN IMPLEMENTATION
Name : DIONA TOWNSEND
Credential :
Telephone Number : 847-916-4513
Provider Enumeration Date : 05/30/2006
Last Update Date : 08/06/2010

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Directions to “AMERICAN DRUG STORES LLC ” Practice Location

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