KANKAKEE IL CVS LLC NPI 1578504445

NPI Information

NPI: 1578504445
Provider Name: KANKAKEE IL CVS LLC
Classification: Pharmacy - 333600000X
Entity Type: Organization
:
CLIA Number: 14D2257869
Address: 420 S WASHINGTON AVE
KANKAKEE, IL
ZIP 60901
Phone: (815) 939-3130

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NPI Details

KANKAKEE IL CVS LLC is a pharmacy in Kankakee, IL. The provider is a facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located. KANKAKEE IL CVS LLC NPI is 1578504445. The provider is registered as an organization entity type.
The provider .

The provider's business location address is:

420 S WASHINGTON AVE
KANKAKEE, IL
ZIP 60901-744
Phone: (815) 939-3130

The provider's authorized official is Cristiana Mauricio .
The authorized official title is Manager Pharmacy Enrollments and has the following contact phone number (401) 770-2937.

The CLIA number assigned to this NPI record is 14D2257869 - pharmacy with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/9/2006 and was last updated on 9/11/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	3336C0003X	Pharmacy	Community/Retail Pharmacy			No
2	333600000X	Pharmacy				Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1478975	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

NPI Synchronization or Removal

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