# AMERICAN DRUG STORES LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** OSCO DRUG \#1254
- **Organization subpart:** No

## Provider details

- **NPI number:** 1780630210
- **Authorized official:** KATHY GIANNAKOPOULOS (ENROLLMENTS MANAGER)
- **Authorized official phone:** (208) 395-3954

## Contact information

- **Practice address:** 7201 W 24TH ST, NORTH RIVERSIDE, IL 60546
- **Practice address phone:** (708) 447-5170
- **Practice address fax:** (708) 447-8490
- **Mailing address:** 250 E PARKCENTER BLVD, MAILSTOP SEC2-B, BOISE, ID 83706-3940
- **Mailing address phone:** (208) 395-6200

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 054-003743 | IL | Yes |

## Other

- **Enumeration date:** 05/26/2006
- **Last updated:** 08/01/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2022379 | PK | — |