Organization
AMERICAN DRUG STORES LLC
Active
Other names
OSCO DRUG #3165
Organization subpart
No
Provider details
NPI number
Authorized official
TIFFANY ELIOPULOS (ASSISTANT MANAGER, ENROLLMENTS)
(208) 395-3906
Entity
Organization
Contact information
Practice address
17113 HARLEM AVE, TINLEY PARK, IL 60477
(708) 532-7477
(708) 532-7391
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
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
054-004975
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2022582
PK
—
Enumeration date
05/26/2006
Last updated
07/10/2018
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