1013998921 NPI number — CAREMARK, L.L.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013998921 NPI number — CAREMARK, L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAREMARK, L.L.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CVS/SPECIALTY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013998921
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/29/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 99794
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60696-7594
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-799-7171
Provider Business Mailing Address Fax Number:
919-799-4364

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1127 BRYN MAWR AVE.
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
REDLANDS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92374-4558
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-799-7171
Provider Business Practice Location Address Fax Number:
909-799-4364
Provider Enumeration Date:
11/08/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MARKOS
Authorized Official First Name:
MARIA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
401-770-3303

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  PHY39314 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X , with the licence number: PHY39314 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336H0001X , with the licence number: PHY39314 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336H0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: PHY39314 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336S0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100121500A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2889031 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0591796 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 648357700 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01104241 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1013998921 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 505282300 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5589207 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: PH335CA , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: PHA393140 . This is a "STATE CHILDREN'S PROGRAM" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 003522200 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0436283 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1013998921 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 64251331 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1013998921 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5402384100 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 56913 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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