KMART STORES OF ILLINOIS LLC (NPI# 1851322903) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1851322903 |
| Entity Type | Organization |
| Organization Name | KMART STORES OF ILLINOIS LLC |
| Other Organization Name | KMART PHARMACY3233 |
| Practice Address |
1321 Sandy Hollow Rd Rockford IL 61109-2120 |
| Mailing Address |
3333 Beverly Rd Ac 367 B Hoffman Estates IL 60179-0001 |
| Practice Telephone | 8152269578 |
| Practice Fax Number | 8152260228 |
| Mailing Telephone | 8472864089 |
| Mailing Fax Number | 8472861603 |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2015-02-06 |
| Authorized Official Name | JENNIFER SPEARES (DIR. OF COMPLIANCE AND ADMIN.) |
| Authorized Official Telephone | 8472865116 |
| 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 |
054-015173 | IL | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PK | 2016871 | 01 |
| Other Name | Type Code |
|---|---|
| KMART PHARMACY3233 | 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 |
1321 SANDY HOLLOW RD |
| City | ROCKFORD |
| State | IL |
| Zip Code | 61109-2120 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346563525 | Modern Dental of Rockford LLC | Dentist | 1321 Sandy Hollow Rd, Rockford, IL 61109-2120 | 2010-03-02 |
| 1265960694 | Isabella Rodriguez | Pharmacist | 1321 Sandy Hollow Rd, Rockford, IL 61109-2120 | 2017-05-30 |
| 1477916187 | Arsen Mysllinj | Pharmacist | 1321 Sandy Hollow Rd, Rockford, IL 61109-2120 | 2016-03-30 |
| 1972941433 | Bradley Edward Neukirch | Pharmacist | 1321 Sandy Hollow Rd, Rockford, IL 61109-2120 | 2013-06-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487164398 | Linda A Morel | Speech-Language Pathologist | 6129 Valley Knoll Drive, Rockford, IL 61109 | 2017-10-05 |
| 1841720315 | Activate Healthcare - Local 23 Clinic | Clinic/Center | 3413 Colony Bay, Rockford, IL 61109 | 2017-06-15 |
| 1255430062 | Suzanne E. Wang | Nurse Practitioner | 4940 East State Street, Rockford Veterans Administration Out Patient Clinic, Rockford, IL 61109 | 2006-09-21 |
| 1073597498 | Peter Joseph Gunther | Optometrist | 2995 Eastrock Dr, Rockford, IL 61109 | 2005-11-30 |
| 1104482769 | Catherine L Hill | Nurse's Aide | 2831 Bildahl St, Rockford, IL 61109-1136 | 2019-05-18 |
| 1962671701 | Rosecrance, Inc. | Substance Abuse Rehabilitation Facility | 3522 Green Dale Dr, Rockford, IL 61109-1575 | 2008-02-26 |
| 1326174665 | Lloyd Hearing Aid Corp | Hearing Instrument Specialist | 4435 Manchester Dr, Rockford, IL 61109-1655 | 2007-02-23 |
| 1710965439 | Gary Michael Briden | Family Medicine | 4423 Manchester Dr, Rockford, IL 61109-1655 | 2006-01-03 |
| 1386092625 | Andrew Palmquist | Hearing Instrument Specialist | 4435 Manchester Dr, Rockford, IL 61109-1655 | 2016-05-26 |
| 1851324289 | Reginald Dinan Quart | Family Medicine | 4423 Manchester Dr, Rockford, IL 61109-1655 | 2006-07-09 |
| Find all providers in zip 61109 | ||||
| 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 |
|---|---|---|---|---|
| 1144790791 | Javon Bea Hospital | Pharmacy | 8201 E Riverside Blvd Ste 1022, Rockford, IL 61114-2300 | 2018-11-27 |
| 1265929749 | Pointcore, Inc. | Pharmacy | 5666 E State St Ste 101, Rockford, IL 61108-2425 | 2018-04-19 |
| 1831558618 | Walgreen Co | Pharmacy | 1100 Broadway Ste 102, Rockford, IL 61104-1429 | 2016-02-22 |
| 1285025346 | Hodels-rubens Pharmacy | Pharmacy | 1029 S Main St, Rockford, IL 61101-1417 | 2015-02-11 |
| 1932116969 | Walgreen Co | Pharmacy | 2323 Charles St, Rockford, IL 61104-1550 | 2006-08-02 |
| 1699780841 | Walgreen Co | Pharmacy | 3803 Auburn St, Rockford, IL 61101-2501 | 2006-07-29 |
| 1235144403 | Walgreen Co | Pharmacy | 2525 S Alpine Rd, Rockford, IL 61108-7812 | 2006-07-29 |
| 1952344335 | Highland Park Cvs LLC | Pharmacy | 2454 S Alpine Rd, Rockford, IL 61108-7882 | 2006-06-14 |
| 1366483232 | Highland Park Cvs LLC | Pharmacy | 3134 11th St, Rockford, IL 61109-2273 | 2006-06-09 |
| 1548201411 | Highland Park Cvs LLC | Pharmacy | 3718 N Main St, Rockford, IL 61103-1612 | 2006-06-09 |
| Find all providers in ROCKFORD | ||||
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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.