KMART STORES OF ILLINOIS LLC


Address: Vermillion Plaza, Pontiac, IL 61764
Phone: 8158445691

KMART STORES OF ILLINOIS LLC (NPI# 1033140199) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1033140199
Entity Type Organization
Organization Name KMART STORES OF ILLINOIS LLC
Other Organization Name KMART PHARMACY9163
Practice Address Vermillion Plaza
Pontiac
IL 61764
Mailing Address 3333 Beverly Rd
Ac 367 B
Hoffman Estates
IL 60179-0001
Practice Telephone 8158445691
Practice Fax Number 8158447862
Mailing Telephone 8472864089
Mailing Fax Number 8472861603
Enumeration Date 2006-07-06
Last Update Date 2012-07-30
Authorized Official Name GHASSAN HOURANI (VP/GMM PHARMACY ADMIN)
Authorized Official Telephone 8472863382
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 333600000X Pharmacy Suppliers
Y 3336C0003X Pharmacy
Specialization: Community/Retail Pharmacy
054-015214 IL Suppliers

Other Provider Identifier

State Issuer Identifier Type Code
NCPDP PROVIDER IDENTIFICATION NUMBER 1459569 01

Other Provider/Organization Names

Other Name Type Code
KMART PHARMACY9163 Doing Business As Name - Organization

Other Provider IDs and Locations

NPI Name Taxonomy Address Enumeration
1679504724 Kmart Stores of Illinois LLC Pharmacy 1608 36th St, Peru, IL 61354-1273 2006-07-06
1215968367 Kmart Stores of Illinois LLC Pharmacy 10205 Grand Ave, Franklin Park, IL 60131-3138 2006-07-06
1548291602 Kmart Stores of Illinois LLC Pharmacy 1500 W Maple St, New Lenox, IL 60451-1529 2006-07-06
1396776456 Kmart Stores of Illinois LLC Pharmacy 13200 Cicero Ave, Crestwood, IL 60445-1426 2006-07-06
1811928971 Kmart Stores of Illinois LLC Pharmacy 840 Plainfield Rd, Willowbrook, IL 60527-5340 2006-07-06
1437180593 Kmart Stores of Illinois LLC Pharmacy 2235 S Eastwood Dr, Woodstock, IL 60098-4606 2006-07-06
1124059282 Kmart Stores of Illinois LLC Pharmacy 2700 Plainfield Rd, Joliet, IL 60435-1165 2006-07-06
1801828652 Kmart Stores of Illinois LLC Pharmacy 11000 S Cicero Ave, Oak Lawn, IL 60453-5504 2006-07-06
1497786545 Kmart Stores of Illinois LLC Pharmacy 901 W Lake Ave, Peoria, IL 61614-5968 2006-07-06
1942231097 Kmart Stores of Illinois LLC Pharmacy 5909 E State St, Rockford, IL 61108-2429 2006-07-06

Office Location

Street Address VERMILLION PLAZA
City PONTIAC
State IL
Zip Code 61764

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1497165211 Barbara Kay Browning Counselor 310 E. Torrance Ave, Pontiac, IL 61764 2014-05-01
1407287121 Institute for Human Resources of Livingston County, Il Community/Behavioral Health 301 E Torrance Ave, Pontiac, IL 61764 2013-12-05
1982031241 Annette G Franzen Psychologist 700 W Lincoln St # 406, Pontiac, IL 61764 2013-10-02
1871739185 Woodridge of Ponitac LLC Assisted Living Facility 120 North Deerfield Road, Pontiac, IL 61764 2008-12-17
1861601171 William Earl Hammond Chiropractor 210b Ladd, Pontiac, IL 61764 2007-05-22
1932259983 Amy Duffy Counselor 210 W Water St Ste 1, Pontiac, IL 61764 2007-01-11
1326123340 Highland Park Cvs, L.L.C. Durable Medical Equipment & Medical Supplies 1034 W. Reynolds Street, Pontiac, IL 61764 2006-10-26
1205932977 Gary Merl Leverton Dentist 518 West Madison St, Pontiac, IL 61764 2006-09-16
1891899886 Robert E Heins Family Medicine 520 West Madison, Madison Street Clinic PC, Pontiac, IL 61764 2006-09-11
1710081708 Kenneth N Jordan Family Medicine 520 West Madison Street, Madison Street Clinic PC, Pontiac, IL 61764 2006-09-11
Find all providers in zip 61764

Taxonomy Information

Taxonomy Code 3336C0003X
Grouping Suppliers
Classification Pharmacy
Specialization Community/Retail Pharmacy

Taxonomy Definition

A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.
Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new]

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1851869275 Best Family Pharmacy LLC Pharmacy 693 Baldwin Ave, Pontiac, MI 48342-1318 2018-11-03
1083019079 Neau Era Pharmacy Pharmacy 506 N Telegraph Rd, Pontiac, MI 48341 2014-11-03
1033545074 Advicare Pharmacy, Inc. Pharmacy 1531 Highwood E, Pontiac, MI 48340-1234 2013-09-23
1295029312 Srisiri Pharma Inc Pharmacy 989 University Dr Ste 107, Pontiac, MI 48342-1885 2011-06-06
1134423957 Auburn Discount Pharmacy Pharmacy 263 Auburn Ave, Pontiac, MI 48342-3012 2011-01-09
1871897660 Omote Rx Inc Pharmacy 1430 Joslyn Ave, Pontiac, MI 48340-2065 2011-01-07
1780992750 Mykal Discount Pharmacy Pharmacy 1101 E Walton Blvd, Pontiac, MI 48340-1591 2010-09-23
1831201771 Woodward Detroit Cvs, L.L.C. Pharmacy 66 E Walton Blvd, Pontiac, MI 48340-1277 2006-08-31
1679893887 Sav-plus Pharmacy Pharmacy 775 Baldwin Ave, Pontiac, MI 48340-2576 2010-06-10
1427234863 Bloomfield Pharmacy North PC Pharmacy 44200 Woodward Ave, Ste 107, Pontiac, MI 48341-5045 2008-01-16
Find all providers in PONTIAC

Competitor

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City PONTIAC
Zip Code 61764

Improve Information

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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