K MART CORP (NPI# 1578594636) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1578594636 |
| Entity Type | Organization |
| Organization Name | K MART CORP |
| Other Organization Name | KMART PHARMACY4108 |
| Practice Address |
6050 Us Highway 6 Portage IN 46368-5047 |
| Mailing Address |
3333 Beverly Rd Ac 367 B Hoffman Estates IL 60179-0001 |
| Practice Telephone | 2197626912 |
| Practice Fax Number | 2197620924 |
| Mailing Telephone | 8472864089 |
| Mailing Fax Number | 8472861603 |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2012-02-10 |
| Authorized Official Name | GHASSAN HOURANI (VP/GMM PHARMACY ADMIN) |
| Authorized Official Telephone | 8472863382 |
| 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 |
60005800A | IN | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 200036490A | 05 | |
| NCPDP PROVIDER IDENTIFICATION NUMBER | 1522019 | 01 |
| Other Name | Type Code |
|---|---|
| KMART PHARMACY4108 | 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 |
6050 US HIGHWAY 6 |
| City | PORTAGE |
| State | IN |
| Zip Code | 46368-5047 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013239847 | Cynthia Jane Walters | Pharmacist | 6050 Us Highway 6, Portage, IN 46368-5047 | 2010-02-21 |
| 1679098198 | Jessica Mcelfresh | Pharmacist | 6050 Us Highway 6, Portage, IN 46368-5047 | 2017-08-04 |
| 1992114193 | Loren Reid | Pharmacist | 6050 Us Highway 6, Portage, IN 46368-5047 | 2014-08-13 |
| 1245640952 | Philip Sloboda | Pharmacist | 6050 Us Highway 6, Portage, IN 46368-5047 | 2014-05-02 |
| 1457796542 | Meijer Stores Limited Partnership | Durable Medical Equipment & Medical Supplies | 6050 Us Highway 6, Portage, IN 46368-5047 | 2013-05-03 |
| 1831533801 | Usv Optical Inc. | Eyewear Supplier (Equipment, not the service) | 6050 Us Highway 6, Portage, IN 46368-5047 | 2013-04-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366041121 | Latresa Renee Sims | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1777 Armstrong St. Suite C., Portage, IN 46368 | 2020-10-22 |
| 1831576693 | Bishara Robert Khoury | Family Medicine | 3545 Arbor Blvd Ste E, Portage, IN 46368 | 2015-04-30 |
| 1962813535 | Diane Farrington | Pharmacist | 6050 Us Hwy 6, Portage, IN 46368 | 2014-05-16 |
| 1588827562 | Jennifer Ann Rumpel | Allergy & Immunology | 6375 Us Highway 6 Ste C, Portage, IN 46368 | 2008-07-09 |
| 1588822688 | Total Renal Care Inc | Clinic/Center | 5823 Us Highway 6, Portage, IN 46368 | 2008-05-27 |
| 1235321480 | Michael Wendahl | Physical Therapist | 3691 Willowcreek Road, Suite 100, Portage, IN 46368 | 2007-08-13 |
| 1679663603 | Stephen V Headley | Family Medicine | 3283 Willowcreek Rd, Portage, IN 46368 | 2006-10-13 |
| 1730276486 | Robert Tan Ang | Psychiatry & Neurology | 3156 Willowcreek Road, Portage, IN 46368 | 2006-10-06 |
| 1013029883 | Primary Care PC | Family Medicine | 3125 Willowcreek Road, Portage, IN 46368 | 2006-08-31 |
| 1104936962 | Margaret Eileen Griffith | Dentist | 2646 Lois Street, Portage, IN 46368 | 2006-08-30 |
| Find all providers in zip 46368 | ||||
| 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 |
|---|---|---|---|---|
| 1972082881 | Dean Retail Services, Inc. | Pharmacy | 2825 Hunters Trl Ste 300, Portage, WI 53901-3429 | 2018-08-10 |
| 1386957207 | Tandon's Advanced Pharmacy Inc. | Pharmacy | 7916 Oakland Dr, Portage, MI 49024-4936 | 2010-07-20 |
| 1437252129 | Hook Superx LLC | Pharmacy | 3240 Willowcreek Rd, Portage, IN 46368-5055 | 2006-09-07 |
| 1922015916 | Walgreen Co | Pharmacy | 5995 Us Highway 6, Portage, IN 46368-4945 | 2006-08-02 |
| 1992735666 | Portage Pharmacy, Inc. | Pharmacy | 7966 Lovers Ln, Portage, MI 49002-4446 | 2006-07-05 |
| 1154389302 | Pharma-card, Inc | Pharmacy | 6036 Lute Rd, Suite A, Portage, IN 46368-5008 | 2006-05-03 |
| 1578162954 | Amanda Marie Goodall | Pharmacy | 2950 New Pinery Rd, Portage, WI 53901-9225 | 2020-10-18 |
| 1588048672 | Walgreens | Pharmacy | 5933 S Westnedge Ave, Portage, MI 49002-1455 | 2015-07-17 |
| 1174677611 | Borgess Medical Center | Pharmacy | 7901 Angling Rd, Portage, MI 49024-0714 | 2007-01-22 |
| 1750440756 | Family Fare, LLC | Pharmacy | 525 Romence Rd, Portage, MI 49024-3444 | 2006-12-06 |
| Find all providers in PORTAGE | ||||
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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.