KMART STORES OF ILLINOIS LLC (NPI# 1689605743) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689605743 |
| Entity Type | Organization |
| Organization Name | KMART STORES OF ILLINOIS LLC |
| Other Organization Name | KMART PHARMACY7399 |
| Practice Address |
1900 Douglas Rd Montgomery IL 60538-2419 |
| Mailing Address |
3333 Beverly Rd Ac 367 B Hoffman Estates IL 60179-0001 |
| Practice Telephone | 6308963000 |
| Practice Fax Number | 6308962056 |
| Mailing Telephone | 8472862527 |
| Mailing Fax Number | 8472861603 |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2013-08-08 |
| Authorized Official Name | ELIZABETH ZANDER (DIRECTOR MANAGED CARE) |
| Authorized Official Telephone | 8472867661 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 333600000X | Pharmacy | Suppliers | ||
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
054-015212 | IL | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PK | 2018209 | 01 |
| Other Name | Type Code |
|---|---|
| KMART PHARMACY7399 | Doing Business As Name - Organization |
| 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 |
| 1033140199 | Kmart Stores of Illinois LLC | Pharmacy | Vermillion Plaza, Pontiac, IL 61764 | 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 |
| Street Address |
1900 DOUGLAS RD |
| City | MONTGOMERY |
| State | IL |
| Zip Code | 60538-2419 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215251194 | Jacqueline J Mai | Pharmacist | 1900 Douglas Rd, Montgomery, IL 60538-2419 | 2010-03-21 |
| 1760706642 | Pamela A Krohn | Pharmacist | 1900 Douglas Rd, Montgomery, IL 60538-2419 | 2010-03-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447594296 | Kristina Nancy Hajek | Physician Assistant | 1851 Douglas Road, Montgomery, IL 60538 | 2012-11-17 |
| 1003025248 | Matthew Thomas Neu | Preventive Medicine | 325 Route 31, Caterpillar Inc, Medical Division, Montgomery, IL 60538 | 2007-05-22 |
| 1477761567 | West Suburban Dental Care, Ltd. | Dentist | 1901 Douglas Rd, Montgomery, IL 60538 | 2007-05-20 |
| 1093834079 | David D Leger | Chiropractor | 2100 Baseline Rd, Montgomery, IL 60538 | 2007-03-28 |
| 1790816650 | Tina Elizabeth Sunderland | Specialist/Technologist | 22 Ashlawn Ave, Montgomery, IL 60538 | 2007-03-09 |
| 1720126535 | Nicholas George Tzanetakos | Family Medicine | 99 Boulder Hill Pass, Montgomery, IL 60538 | 2007-02-02 |
| 1184638603 | Neil Stewart Schlupp | Chiropractor | 212 Webster Street, Montgomery, IL 60538 | 2006-07-28 |
| 1275570061 | Ridge Ambulance Service Inc | Ambulance | 1851 Aucutt Rd, Montgomery, IL 60538 | 2006-06-01 |
| 1487855839 | Linda Gioia Arrich | Dentist | 1901 Douglas Rd, Montgomery, IL 60538 | 2007-05-31 |
| 1750508339 | Michael Harry Kontos | Dentist | 20 Boulder Hill Pass, Montgomery, IL 60538 | 2007-04-18 |
| Find all providers in zip 60538 | ||||
| Taxonomy Code | 3336C0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Community/Retail Pharmacy |
| 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] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447814033 | Triple T Pharmacy LLC | Pharmacy | 461 Cotton Gin Rd Ste B, Montgomery, AL 36117-3558 | 2019-04-29 |
| 1114486800 | Jmjp Investments LLC | Pharmacy | 89 Boulder Hill Pass, Montgomery, IL 60538-1911 | 2019-03-13 |
| 1750853529 | Aim 2016, Inc | Pharmacy | 7212 Halcyon Park Dr, Montgomery, AL 36117-7717 | 2018-12-18 |
| 1841760071 | Cvs Pharmacy Inc | Pharmacy | 20125 Eva Street, Montgomery, TX 77356 | 2018-11-30 |
| 1770072415 | Crosby Pharmacy & Wellness, LLC | Pharmacy | 18446 Tx - 105 Ste D, Montgomery, TX 77356 | 2018-05-08 |
| 1124468210 | Montgomery Drug Company Inc. | Pharmacy | 1633 Perry Hill Rd, Montgomery, AL 36106-2729 | 2013-07-03 |
| 1508042086 | Hudson Valley Ltc Pharmacy Inc | Pharmacy | 105 Ward St Ste A, Montgomery, NY 12549-1150 | 2008-01-15 |
| 1851427850 | Walgreen Co | Pharmacy | 2920 Carter Hill Rd, Montgomery, AL 36106-2531 | 2007-02-26 |
| 1659446904 | Montgomery Drug Company Inc | Pharmacy | 37 Mitchell Dr, Montgomery, AL 36109-2923 | 2006-11-22 |
| 1477624070 | Vel LLC | Pharmacy | 8189 Vaughn Rd, Montgomery, AL 36116-6705 | 2006-11-13 |
| Find all providers in MONTGOMERY | ||||
| City | MONTGOMERY |
| Zip Code | 60538 |
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| 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.