Organization
AMERICAN DRUG STORES LLC
Active
Other names
OSCO DRUG #3515
Organization subpart
No
Provider details
NPI number
Authorized official
TIFFANY ELIOPULOS (ASSISTANT MANAGER, ENROLLMENT)
(208) 395-3906
Entity
Organization
Contact information
Practice address
543 W LIBERTY ST, WAUCONDA, IL 60084
(847) 526-1239
(847) 526-3883
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
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
054-009177
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2019289
PK
—
Enumeration date
05/30/2006
Last updated
07/09/2018
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