Organization
AMERICAN DRUG STORES LLC
Active
Other names
OSCO DRUG #3176
Organization subpart
No
Provider details
NPI number
Authorized official
TIFFANY ELIOPULOS (ASSISTANT MANAGER, ENROLLMENTS)
(208) 395-3906
Entity
Organization
Contact information
Practice address
9402 S ASHLAND AVE, CHICAGO, IL 60620
(773) 779-0017
(773) 779-8153
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
054-010027
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2021080
PK
—
Enumeration date
06/02/2006
Last updated
07/10/2018
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