1326029323 NPI number — CAREMARK, L.L.C.

Table of content: (NPI 1326029323)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326029323 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:
CAREMARK HAWAII SPECIALTY PHARMACY, LLC DBA CVS CAREMARK
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:
1326029323
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/15/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 840688
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75284-0688
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-225-5967
Provider Business Mailing Address Fax Number:
909-799-4364

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
970 N KALAHEO AVE
Provider Second Line Business Practice Location Address:
STE C106 PALI PALMS PLAZA
Provider Business Practice Location Address City Name:
KAILUA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96734-1866
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-834-8447
Provider Business Practice Location Address Fax Number:
808-254-6153
Provider Enumeration Date:
11/08/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GOLDING
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
W.
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
800-225-5967

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  PHY 663 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X , with the licence number: PHY633 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336H0001X , with the licence number: PHY663 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: PHY663 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: H0000PCCCZ . This is a "MEDICARE B" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: C0098972 , issued by the state of ( GU ) . This identifiers is of the category "MEDICAID".
  • Identifier: 56672101 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".




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