Provider Demographics
NPI:1295041341
Name:TRANSFORM KM LLC
Entity Type:Organization
Organization Name:TRANSFORM KM LLC
Other - Org Name:KMART PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEAD OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:SPEARES LEHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-286-5116
Mailing Address - Street 1:3333 BEVERLY RD # BC260A
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60179-0001
Mailing Address - Country:US
Mailing Address - Phone:847-286-4089
Mailing Address - Fax:847-747-1553
Practice Address - Street 1:3333 BEVERLY RD # BC260A
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60179-0001
Practice Address - Country:US
Practice Address - Phone:847-286-4089
Practice Address - Fax:847-747-1553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-27
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy