Provider Demographics
NPI: | 1821217993 |
---|---|
Name: | AMERICAN DRUG STORES LLC |
Entity Type: | Organization |
Organization Name: | AMERICAN DRUG STORES LLC |
Other - Org Name: | OSCO PHARMACY |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | MANG PLAN IMPL |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JULIE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | SCHRIENER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 847-916-4711 |
Mailing Address - Street 1: | 800 NORTH MAIN ST |
Mailing Address - Street 2: | |
Mailing Address - City: | ELBURN |
Mailing Address - State: | IL |
Mailing Address - Zip Code: | 60119 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 800 NORTH MAIN ST |
Practice Address - Street 2: | |
Practice Address - City: | ELBURN |
Practice Address - State: | IL |
Practice Address - Zip Code: | 60119 |
Practice Address - Country: | US |
Practice Address - Phone: | 630-365-4240 |
Practice Address - Fax: | 630-365-4245 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-04-25 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 3336C0003X | Suppliers | Pharmacy | Community/Retail Pharmacy |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
1480689 | Other | OTHER ID NUMBER-COMMERCIAL NUMBER |