Organization
AMERICAN DRUG STORES LLC
Active
Other names
OSCO DRUG #2488
Organization subpart
No
Provider details
NPI number
Authorized official
DEMOND HAWKINS (THIRD PARTY MANAGER)
(208) 395-3905
Entity
Organization
Contact information
Practice address
655 MAIN ST NW, BOURBONNAIS, IL 60914
(815) 929-0590
(815) 929-1433
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
054-008105
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2018129
PK
—
Enumeration date
05/25/2006
Last updated
06/18/2018
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