# AMERICAN DRUG STORES LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** OSCO DRUG \#3770
- **Organization subpart:** No

## Provider details

- **NPI number:** 1538115928
- **Authorized official:** TIFFANY ELIOPULOS (ASSISTANT MANAGER, ENROLLMENTS)
- **Authorized official phone:** (208) 395-3906

## Contact information

- **Practice address:** 107 AVENUE OF THE CITIES, EAST MOLINE, IL 61244
- **Practice address phone:** (309) 751-0960
- **Practice address fax:** (309) 751-0985
- **Mailing address:** 250 E PARKCENTER BLVD, MAILSTOP SEC2-B, BOISE, ID 83706-3940

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 054-004278 | IL | Yes |

## Other

- **Enumeration date:** 05/26/2006
- **Last updated:** 07/19/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2022484 | PK | — |