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Organization
AMERICAN DRUG STORES LLC
Active
Organization
AMERICAN DRUG STORES LLC
Active
Other names
OSCO DRUG #1254
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENTS MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
7201 W 24TH ST, NORTH RIVERSIDE, IL 60546
(708) 447-5170
(708) 447-8490
Mailing address
250 E PARKCENTER BLVD, MAILSTOP SEC2-B, BOISE, ID 83706-3940
(208) 395-6200
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
054-003743
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2022379
PK
—
Enumeration date
05/26/2006
Last updated
08/01/2024
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