Provider Demographics
NPI:1629353859
Name:AMERICAN DRUG STORES LLC
Entity Type:Organization
Organization Name:AMERICAN DRUG STORES LLC
Other - Org Name:OSCO DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASST MGR PLAN IMPLEMENTATION
Authorized Official - Prefix:
Authorized Official - First Name:DIONA
Authorized Official - Middle Name:
Authorized Official - Last Name:TOWNSEND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-916-4513
Mailing Address - Street 1:3030 CULLERTON ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60131-2205
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1414 N DIVISION ST
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-1583
Practice Address - Country:US
Practice Address - Phone:815-941-2353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUPERVALU INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
1476539OtherNCPDP PROVIDER NUMBER