KMART STORES OF ILLINOIS LLC (NPI# 1700817863) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1700817863 |
| Entity Type | Organization |
| Organization Name | KMART STORES OF ILLINOIS LLC |
| Other Organization Name | KMART PHARMACY7304 |
| Practice Address |
3404 Broadway St Mount Vernon IL 62864-2267 |
| Mailing Address |
3333 Beverly Rd Ac 367 B Hoffman Estates IL 60179-0001 |
| Practice Telephone | 6182446550 |
| Practice Fax Number | 6182445258 |
| 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 |
054-015211 | IL | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PK | 2017678 | 01 |
| Other Name | Type Code |
|---|---|
| KMART PHARMACY7304 | 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 |
3404 BROADWAY ST |
| City | MOUNT VERNON |
| State | IL |
| Zip Code | 62864-2267 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336502996 | Timothy Lynn | Pharmacist | 3404 Broadway St, Mount Vernon, IL 62864-2267 | 2016-03-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619438892 | Melissa Pryer | Dietitian, Registered | 2020 Broadway, Suite 1, Mt. Vernon, IL 62864 | 2019-03-28 |
| 1487145454 | Chiropractic Wellness Center of Mt Vernon, LLC. | Chiropractor | 1009 S 42nd St Ste 5, Mount Vernon, IL 62864 | 2018-05-24 |
| 1851889208 | Kimberly Tate | Counselor | 4110 North Water Place, Mt. Vernon, IL 62864 | 2018-05-01 |
| 1871907790 | University Hematology Oncology Inc | Specialist | #11 Cusumano Professional Plaza, Mount Vernon, IL 62864 | 2014-06-18 |
| 1457771677 | Dynamic Counseling and Consultation Services | Social Worker | 3600 S Water Tower Pl, Mt Vernon, IL 62864 | 2014-04-27 |
| 1619239431 | Judith C Morgan | Counselor | 16338 N Illinois Hwy 37, Mount Vernon, IL 62864 | 2012-06-08 |
| 1073888624 | James Brian Verges | Counselor | 16338 N. Illinois Hwy 37, Mount Vernon, IL 62864 | 2012-03-15 |
| 1720352271 | Lucinda M. Holdren | Counselor | 16338 North Illinois Highway 37, Mount Vernon, IL 62864 | 2012-03-01 |
| 1780978627 | Jamie M Orange | Physical Therapy Assistant | 19958 Fairfield Rd, Mt. Vernon, IL 62864 | 2011-06-08 |
| 1780978791 | Wendy Marie Claytor | Speech-Language Pathologist | 600 E Il Hwy 15, Mount Vernon, IL 62864 | 2011-06-07 |
| Find all providers in zip 62864 | ||||
| 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 |
|---|---|---|---|---|
| 1114545571 | Medlife Pharmacy LLC | Pharmacy | 213 Highway 37 Ste 200&300, Mount Vernon, TX 75457-3106 | 2020-07-10 |
| 1396175345 | Allcare PC | Pharmacy | 115 Spring St, Mount Vernon, GA 30445 | 2013-11-12 |
| 1811040918 | Brown & Cole Stores LLC | Pharmacy | 1515 N 18th St, Mount Vernon, WA 98273-2675 | 2007-01-19 |
| 1649374695 | Marco Pharmacy and Optical Inc | Pharmacy | 4121 S Water Tower Pl, Mount Vernon, IL 62864-6293 | 2006-09-12 |
| 1992808695 | Hook Superx LLC | Pharmacy | 700 E 4th St, Mount Vernon, IN 47620-2011 | 2006-09-07 |
| 1467555235 | Highland Park Cvs, L.L.C. | Pharmacy | 2700 Broadway St, Mount Vernon, IL 62864-2342 | 2006-09-07 |
| 1316970650 | Haggen, Inc | Pharmacy | 2601 E Division St, Mount Vernon, WA 98274-4748 | 2006-07-09 |
| 1417923012 | Mt Vernon Community Pharmacy Inc | Pharmacy | 2339 Broadway St, Mount Vernon, IL 62864-2925 | 2006-02-24 |
| 1619592763 | Knox Community Hospital | Pharmacy | 1330 Coshocton Ave, Mount Vernon, OH 43050-1495 | 2020-06-15 |
| 1639644156 | Mabd Enterprises, LLC | Pharmacy | 115 W Spring St, Mount Vernon, GA 30445-2957 | 2018-10-11 |
| Find all providers in MOUNT VERNON | ||||
| City | MOUNT VERNON |
| Zip Code | 62864 |
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.