Organization
AMERICAN DRUG STORES LLC
Active
Other names
OSCO DRUG #3061
Organization subpart
No
Provider details
NPI number
Authorized official
TIFFANY ELIOPULOS (ENROLLMENT ASSISTANT MANAGER)
(208) 395-3906
Entity
Organization
Contact information
Practice address
1150 W MAPLE AVE, MUNDELEIN, IL 60060
(847) 970-9324
(847) 970-9341
Mailing address
250 E PARKCENTER BLVD, BOISE, ID 83706-3940
(208) 395-3963
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
054-020201
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2164294
PK
—
Enumeration date
09/22/2016
Last updated
06/28/2018
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