KMART STORES OF ILLINOIS LLC (NPI# 1497786545) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1497786545 |
| Entity Type | Organization |
| Organization Name | KMART STORES OF ILLINOIS LLC |
| Other Organization Name | KMART PHARMACY9335 |
| Practice Address |
901 W Lake Ave Peoria IL 61614-5968 |
| Mailing Address |
3333 Beverly Rd Ac 367 B Hoffman Estates IL 60179-0001 |
| Practice Telephone | 3096822761 |
| Practice Fax Number | 3096824267 |
| Mailing Telephone | 8472864089 |
| Mailing Fax Number | 8472861603 |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2014-10-30 |
| Authorized Official Name | DAIN RUSK (VP/GM PHARMACY) |
| Authorized Official Telephone | 8472863348 |
| 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 |
054-015216 | IL | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PK | 2016723 | 01 |
| Other Name | Type Code |
|---|---|
| KMART PHARMACY9335 | 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 |
| 1942231097 | Kmart Stores of Illinois LLC | Pharmacy | 5909 E State St, Rockford, IL 61108-2429 | 2006-07-06 |
| Street Address |
901 W LAKE AVE |
| City | PEORIA |
| State | IL |
| Zip Code | 61614-5968 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134551211 | William Kevin Brummitt | Pharmacist | 901 W Lake Ave, Peoria, IL 61614-5968 | 2013-07-31 |
| 1285061887 | Bret Boucher | Pharmacist | 901 W Lake Ave, Peoria, IL 61614-5968 | 2013-09-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548818511 | Christine Svoboda | Social Worker | 6919 N Knoxville Ave Ste 100 and 202, Peoria, IL 61614 | 2019-09-03 |
| 1639649007 | Kathy Karouzos Counseling, LLC | Clinic/Center | 330 W. Ivy Ln., Peoria, IL 61614 | 2018-11-28 |
| 1205312790 | Kathleen Marie Hendricks | Nurse Practitioner | 2809 W Willow Knolls Dr, Peoria, IL 61614 | 2018-07-17 |
| 1629563937 | Mary Elizabeth Cunningham | Counselor | 6219 N. Eldorado Dr., Peoria, IL 61614 | 2018-06-28 |
| 1861937955 | Angela Gilles | Social Worker | 6919 N Knoxville Ave Ste 100, Peoria, IL 61614 | 2016-12-27 |
| 1467994897 | Melissa Saxsma | Specialist | 5009 N Executive Dr, Peoria, IL 61614 | 2016-11-16 |
| 1902258874 | Rashid Plastic Surgery, LLC | Plastic Surgery | 804 W Trailcreek Drive, Peoria, IL 61614 | 2016-07-05 |
| 1215313143 | Melissa Lynn Phelan | Nurse Practitioner | 122 E Morningside Dr, Peoria, IL 61614 | 2015-08-03 |
| 1811380165 | All Ways Caring Services, Inc. | In Home Supportive Care | 6919 N Knoxville Ave, Suite 102, Peoria, IL 61614 | 2015-03-11 |
| 1568875920 | Schuler & Arkwell Orthodontic Partnership | Dentist | 2425 Cornerstone Ct. Ste. A, Peoria, IL 61614 | 2014-06-03 |
| Find all providers in zip 61614 | ||||
| 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 |
|---|---|---|---|---|
| 1831573021 | Hy Vee Inc | Pharmacy | 7610 N Orange Prairie Road, Peoria, IL 61615 | 2015-07-17 |
| 1184842718 | Harbor Vista | Pharmacy | 9133 W Thunderbird, #102, Peoria, AZ 85381 | 2007-04-20 |
| 1053415943 | German Dobson Cvs, L.L.C. | Pharmacy | 7530 W Cactus Rd, Peoria, AZ 85381-5202 | 2006-09-12 |
| 1750485645 | Cvs 3745 Peoria LLC | Pharmacy | 10727 W Olive Ave, Peoria, AZ 85345-9202 | 2006-09-12 |
| 1831293729 | German Dobson Cvs, L.L.C. | Pharmacy | 8332 W Thunderbird Rd, Peoria, AZ 85381-4822 | 2006-09-12 |
| 1093818866 | Highland Park Cvs, L.L.C. | Pharmacy | 3015 N Sterling Ave, Peoria, IL 61604-2259 | 2006-09-07 |
| 1114020880 | Highland Park Cvs, L.L.C. | Pharmacy | 9315 N Lindbergh Dr, Peoria, IL 61615-1454 | 2006-09-07 |
| 1053350439 | Albertsons LLC | Pharmacy | 7575 W Cactus Rd, Peoria, AZ 85381-5201 | 2006-06-04 |
| 1578513834 | Bogard Drug No. 5, Inc. | Pharmacy | 1102 S Western Ave, Peoria, IL 61605-3356 | 2006-05-10 |
| 1881000339 | Westgaterx Pharmacy | Pharmacy | 8914 N 91st Ave, S 100c, Peoria, AZ 85345-8396 | 2014-07-04 |
| Find all providers in PEORIA | ||||
Please comment or provide details below to improve the information on KMART STORES OF ILLINOIS LLC.
| 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.