KMART STORES OF ILLINOIS LLC (NPI# 1174554232) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174554232 |
| Entity Type | Organization |
| Organization Name | KMART STORES OF ILLINOIS LLC |
| Other Organization Name | KMART PHARMACY3422 |
| Practice Address |
2851 Homer M Adams Pkwy Alton IL 62002-4856 |
| Mailing Address |
3333 Beverly Rd Ac 367 B Hoffman Estates IL 60179-0001 |
| Practice Telephone | 6184628223 |
| Practice Fax Number | 6184634634 |
| 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 |
054-015181 | IL | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PK | 2017580 | 01 |
| Other Name | Type Code |
|---|---|
| KMART PHARMACY3422 | 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 |
2851 HOMER M ADAMS PKWY |
| City | ALTON |
| State | IL |
| Zip Code | 62002-4856 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407172067 | Deanna Nicole Taylor | Pharmacist | 2851 Homer M Adams Pkwy, Alton, IL 62002-4856 | 2010-04-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285272807 | Jersey Community Hospital | Obstetrics & Gynecology | #2 Memorial Drive, Suite 203, Alton, IL 62002 | 2019-12-13 |
| 1912540659 | Kelsi N Harre | Community Health Worker | 2603 N. Rogers Ave., Alton, IL 62002 | 2019-10-25 |
| 1841848322 | Destiny L Miller | Technician | 3429 Meridocia St, Alton, IL 62002 | 2019-08-28 |
| 1942854633 | Jessica Leigh Jump | Speech-Language Pathologist | 453 Bluff Street, Alton, IL 62002 | 2019-07-30 |
| 1194380741 | Vasiliki Kytridou | Dentist | 2800 College Avenue Southern Il University School of De, Building 285, Alton, IL 62002 | 2019-05-08 |
| 1982125910 | Amy Nicole Spalding | Social Worker | 1123 Harrison St, Alton, IL 62002 | 2017-06-29 |
| 1962856310 | Patricia Gregory | Social Worker | 5090 Humbert Rd, Alton, IL 62002 | 2016-04-21 |
| 1447612510 | Alanna Lynn Mcnelly | Chiropractor | 219 Piasa St, Suite 200, Alton, IL 62002 | 2016-03-28 |
| 1174983050 | Roberta's Lovely Ladies Boutique | Mastectomy Fitter | 603 W. Delmar, Alton, IL 62002 | 2016-03-04 |
| 1184081556 | Darcy Graham | Nurse Practitioner | 4 Memorial Dr # 210, Alton, IL 62002 | 2016-01-15 |
| Find all providers in zip 62002 | ||||
| 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 |
|---|---|---|---|---|
| 1164770822 | S & W Healthcare | Pharmacy | 603 N Hwy 160, Alton, MO 65606 | 2012-08-28 |
| 1164585782 | Cvs Pharmacy Inc | Pharmacy | 105 Alton Blvd, Alton, TX 78573-1629 | 2006-12-18 |
| 1801999677 | Highland Park Cvs, L.L.C. | Pharmacy | 2422 College Ave, Alton, IL 62002-4609 | 2006-09-07 |
| 1811902026 | Walgreen Co | Pharmacy | 2610 State St, Alton, IL 62002-5150 | 2006-07-29 |
| 1982619151 | Walgreen Co | Pharmacy | 1650 Washington Ave, Alton, IL 62002-3931 | 2006-07-29 |
| 1982001996 | Shields Family Pharmacy, LLC | Pharmacy | 1 Professional Dr Ste 170, Alton, IL 62002-5069 | 2014-11-20 |
| 1881607422 | North Alton Pharmacy Inc | Pharmacy | 2601 State St, Alton, IL 62002-5151 | 2006-08-14 |
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|---|---|---|---|---|
| 1215538582 | Wilmington Pharmacy LLC | Pharmacy | 600 W Baltimore St, Wilmington, IL 60481-1281 | 2020-11-03 |
| 1952909632 | Cordant Pharmacy Illinois, LLC | Pharmacy | 8623 W Bryn Mawr Ave Ste 504, Chicago, IL 60631-3525 | 2020-10-14 |
| 1386242352 | Letitride, Inc. | Pharmacy | 501 W Oak Street, Fairbury, IL 61739 | 2020-10-13 |
| 1699389890 | J2sb LLC | Pharmacy | 398 W Army Trail Rd Ste 120, Bloomingdale, IL 60108-2398 | 2020-09-04 |
| 1891308045 | Apotheco Pharmacy Lincoln Park LLC | Pharmacy | 2140 N Halsted St, Chicago, IL 60614-4385 | 2020-08-27 |
| 1982217345 | Costco Wholesale Corporation | Pharmacy | 2002 N. Neil St., Champaign, IL 61820 | 2020-08-26 |
| 1710599485 | Costco Wholesale Corporation | Pharmacy | 16261 S Boulevard Pl, Plainfield, IL 60586-4400 | 2020-08-23 |
| 1982212635 | Grand Pharmacy LLC | Pharmacy | 229 W Grand Ave Ste F, Bensenville, IL 60106-3365 | 2020-07-20 |
| 1871110254 | Illini Clinic Pharmacy Inc | Pharmacy | 103 N Prospect St, Cambridge, IL 61238-1148 | 2020-07-01 |
| 1831716745 | The Project of The Quad Cities | Pharmacy | 1701 River Dr Ste 106, Moline, IL 61265-1384 | 2020-06-26 |
| Find all providers with the same taxonomy | ||||
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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.