K MART CORP (NPI# 1538190681) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1538190681 |
| Entity Type | Organization |
| Organization Name | K MART CORP |
| Other Organization Name | KMART PHARMACY4034 |
| Practice Address |
2803 Brewerton Rd Mattydale NY 13211-1003 |
| Mailing Address |
3333 Beverly Rd Ac 367 B Hoffman Estates IL 60179-0001 |
| Practice Telephone | 3154557401 |
| Practice Fax Number | 3154557529 |
| Mailing Telephone | 8472864089 |
| Mailing Fax Number | 8472861603 |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2015-02-04 |
| 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 |
017542 | NY | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PK | 2061373 | 01 | |
| NY | 00734510 | 05 |
| Other Name | Type Code |
|---|---|
| KMART PHARMACY4034 | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841621695 | K Mart Corp | Pharmacy | 25 W Polk St, Coalinga, CA 93210-2366 | 2013-12-04 |
| 1437397411 | K Mart Corp | Pharmacy | Carr. Pr-156 Km 54.00, Las Catalinas Mall, Local 4858, Caguas, PR 00726 | 2009-01-28 |
| 1336256007 | K Mart Corp | Pharmacy | 3625 E 18th St, Antioch, CA 94509-8511 | 2006-08-25 |
| 1205943974 | K Mart Corp | Pharmacy | 1050 N Davis Rd, Salinas, CA 93907-1944 | 2006-08-25 |
| 1437177102 | K Mart Corp | Pharmacy | 5665 Rosemead Blvd, Temple City, CA 91780-1804 | 2006-07-18 |
| 1154352284 | K Mart Corp | Pharmacy | Rte 12 A, West Lebanon, NH 03784 | 2006-07-06 |
| 1093746117 | K Mart Corp | Pharmacy | 1501 Us 1, Vero Beach, FL 32960-5735 | 2006-07-06 |
| 1417988486 | K Mart Corp | Pharmacy | 1581 Us 68, Maysville, KY 41056-9178 | 2006-07-06 |
| 1902837040 | K Mart Corp | Pharmacy | Route 70 E, Marlton, NJ 08053 | 2006-07-06 |
| 1780615815 | K Mart Corp | Pharmacy | 129 Mall Rd, Covington, VA 24426-2413 | 2006-07-06 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Colorado Business Entities | K MART CORPORATION | 3333 Beverly Road, Hoffman Estates, IL 60179 |
| Iowa Business Entities | K MART CORPORATION | 3333 Beverly Road, Hoffman Estates, IL 60179 |
| Connecticut Business Registrations | K MART CORPORATION | 3333 Beverly Road, Hoffman Estates, IL 60179 |
| Oregon Corporations, Companies and Business Names | K MART CORPORATION | 3333 Beverly Rd, Hoffman Estates, IL 60179 |
| Virginia Business Entities | K MART CORPORATION | 3333 Beverly Rd, Hoffman Estates, Illinois 60179 |
| New York State Corporations | K MART CORPORATION | 28 Liberty St., New York, New York 10005 |
| Oklahoma Business Registrations | K MART CORPORATION | 3333 Beverly Rd, Hoffman Estates, IL 60179 |
| Washington State Corporations | K MART CORPORATION | 3333 Beverly Rd, Hoffman Estates, IL 60179-0001 |
| Street Address |
2803 BREWERTON RD |
| City | MATTYDALE |
| State | NY |
| Zip Code | 13211-1003 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770605784 | John Palazzoli | Pharmacist | 2803 Brewerton Rd, Mattydale, NY 13211-1003 | 2007-04-03 |
| 1407283161 | Andrea Marie Rubin | Pharmacist | 2803 Brewerton Rd, Mattydale, NY 13211-1003 | 2013-09-26 |
| 1689007585 | Justin Christopher Acker | Pharmacist | 2803 Brewerton Rd, Mattydale, NY 13211-1003 | 2013-08-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154692259 | Elizabeth Mitchell | Massage Therapist | 2605 Brewerton Roadd Lin, A Touch Above, Mattydale, NY 13211 | 2012-01-20 |
| 1265616189 | James Laurence Devine | Pharmacist | 2616 Brewerton Rd, Mattydale, NY 13211 | 2007-12-27 |
| 1578053468 | Kalie Jolyn Moore | Massage Therapist | 2605 Brewerton Rd, Syracuse, NY 13211 | 2018-05-16 |
| 1487997276 | Melissa S Mcgloun | Massage Therapist | 2605 Brewerton Rd, A Touch Above, Mattydale, NY 13211 | 2013-04-01 |
| 1215044201 | Clinton Charles Conger | Chiropractor | 2605 Brewerton Rd, Mattydale, NY 13211-1147 | 2006-08-24 |
| 1962055954 | Corey Smith | Massage Therapist | 2605 Brewerton Rd, Mattydale, NY 13211-1147 | 2019-07-19 |
| 1306316484 | Samantha Marie Rawson | Massage Therapist | 2605 Brewerton Rd, Mattydale, NY 13211-1147 | 2018-11-30 |
| 1053800128 | Kara Elisabeth Shostack | Massage Therapist | 2605 Brewerton Rd, Mattydale, NY 13211-1147 | 2018-05-04 |
| 1447757950 | Tiffani Lynn Rombach | Massage Therapist | 2605 Brewerton Rd, Mattydale, NY 13211-1147 | 2018-04-11 |
| 1427557578 | Lisa Renee Kozma | Massage Therapist | 2605 Brewerton Rd, Syracuse, NY 13211-1147 | 2018-02-05 |
| Find all providers in zip 13211 | ||||
| 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] |
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| 1477151512 | 101 Rx Pharmacy Inc | Pharmacy | 101 Rx Pharmacy Inc, 9718 101st Ave, Ozone Park, NY 11416 | 2020-10-12 |
| 1043818289 | Xuwei Lin | Pharmacy | 8218 14th Ave, Brooklyn, NY 11228-3114 | 2020-10-10 |
| 1043817463 | Angella Samson | Pharmacy | 1346 Granville Payne Ave, Brooklyn, NY 11239-2103 | 2020-10-08 |
| 1366059792 | Community Healthcare Network Inc. | Pharmacy | 999 Blake Ave Fl 1, Brooklyn, NY 11208-3535 | 2020-09-29 |
| 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.