KMART STORES OF ILLINOIS LLC (NPI# 1215968375) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1215968375 |
| Entity Type | Organization |
| Organization Name | KMART STORES OF ILLINOIS LLC |
| Other Organization Name | KMART PHARMACY3758 |
| Practice Address |
1101 Belt Line Rd Collinsville IL 62234-4368 |
| Mailing Address |
3333 Beverly Rd Ac 367 B Hoffman Estates IL 60179-0001 |
| Practice Telephone | 6183468883 |
| Practice Fax Number | 6183469041 |
| Mailing Telephone | 8472864089 |
| 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 |
054-015189 | IL | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PK | 2019962 | 01 |
| Other Name | Type Code |
|---|---|
| KMART PHARMACY3758 | 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 |
1101 BELT LINE RD |
| City | COLLINSVILLE |
| State | IL |
| Zip Code | 62234-4368 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497077184 | Carol O Muzzarelli | Pharmacist | 1101 Belt Line Rd, Collinsville, IL 62234-4368 | 2010-02-22 |
| 1861092363 | Emily Marie Shepherd | Pharmacist | 1101 Belt Line Rd, Collinsville, IL 62234-4368 | 2020-10-26 |
| 1346898129 | Kelsey Gene Salmon | Pharmacist | 1101 Belt Line Rd, Collinsville, IL 62234-4368 | 2019-08-26 |
| 1255865853 | Wal-mart Stores Inc | Durable Medical Equipment & Medical Supplies | 1101 Belt Line Rd, Collinsville, IL 62234-4368 | 2017-04-20 |
| 1710209580 | Ray A Muzzarelli | Pharmacist | 1101 Belt Line Rd, Collinsville, IL 62234-4368 | 2010-02-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730791005 | Kendall Kotter | Pharmacist | 401 Beltline Rd, Collinsville, IL 62234 | 2020-08-18 |
| 1851804207 | Apex Physical Therapy, LLC | Clinic/Center | 1095 Beltine Rd., Ste. 400, Collinsville, IL 62234 | 2017-11-08 |
| 1205361110 | Pc Associates, LLC | Family Medicine | 1095 Beltline Road, Suite 500, Collinsville, IL 62234 | 2017-04-28 |
| 1538405451 | Joan M Polwort | Pharmacist | 801 Braidwood Ct, Collinsville, IL 62234 | 2012-12-20 |
| 1275818080 | Stephen Scott Branding | Pharmacist | 401 Beltline Rd., Collinsville, IL 62234 | 2011-10-13 |
| 1447534417 | Lindsay Eakin | Pharmacist | 401 Beltline, Collinsville, IL 62234 | 2011-10-07 |
| 1700171568 | Patrick Joseph Swierczek | Social Worker | 820 St. Louis Rd Apt#232, Collinsville, IL 62234 | 2011-06-09 |
| 1366670887 | Susan M. Smith Dc LLC | Chiropractor | 226 South Morrison, Collinsville, IL 62234 | 2009-06-23 |
| 1649418492 | Lynette M Patton | Counselor | 415 W Main St Ste 3, Collinsville, IL 62234 | 2009-02-02 |
| 1558506626 | Kimberly Jean Miller | Counselor | Meadow Heights Professional Park, Suite 2b, Collinsvile, IL 62234 | 2008-12-03 |
| Find all providers in zip 62234 | ||||
| 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 |
|---|---|---|---|---|
| 1356444095 | Virginia Cvs Pharmacy LLC | Pharmacy | 3001 Virginia Ave, Collinsville, VA 24078-2244 | 2006-09-07 |
| 1154336311 | Walgreen Co | Pharmacy | 401 Belt Line Rd, Collinsville, IL 62234-4406 | 2006-07-29 |
| 1043255912 | Courtney Pharmacies, PC | Pharmacy | 8201a Collinsville Rd, Collinsville, IL 62234-7613 | 2006-06-17 |
| 1447349717 | Evers Pharmacy | Pharmacy | 417 W Main St, Collinsville, IL 62234-3004 | 2006-10-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 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 | ||||
| City | COLLINSVILLE |
| Zip Code | 62234 |
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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.