Organization
AMERICAN DRUG STORES LLC
Active
Other names
OSCO DRUG #1118
Organization subpart
No
Provider details
NPI number
Authorized official
TIFFANY ELIOPULOS (ASSISTANT MANAGER, ENROLLMENTS)
(208) 395-3906
Entity
Organization
Contact information
Practice address
1309 N 2ND ST, CLINTON, IA 52732
(563) 243-6641
(563) 243-8354
Mailing address
250 E PARKCENTER BLVD, MAILSTOP SEC2-B, BOISE, ID 83706-3940
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
054-017791
IL
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
105
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0070763
—
IA
01
—
2025912
PK
—
Enumeration date
05/26/2006
Last updated
07/20/2018
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